Miyako Hatano

Vitamin E and vitamin C in the treatment of idiopathic sudden sensorineural hearing loss.

Conclusion. The results of this study suggest that the administration of vitamin E and vitamin C to patients with idiopathic sudden sensorineural hearing loss (ISSHL) has beneficial effects by reducing the level of reactive oxygen metabolites produced by inner ear ischaemia and reperfusion injury after treatment. Objectives. The purpose of this study was to investigate the efficacy of antioxidant vitamin E and vitamin C in the treatment of ISSHL. Patients and methods. In a retrospective chart review, a total of 87 patients were enrolled who fulfilled the following inclusion criteria: 1) sudden onset of sensorineural hearing loss, 2) cause of hearing loss unknown, 3) hearing loss did not fluctuate, 4) arithmetic mean of hearing levels at 250, 500, 1000, 2000 and 4000 Hz exceeded 40 dB and 5) treatment was started within 14 days from the onset of hearing loss. All the patients were treated with steroids and/or alprostadil. In the study group, patients additionally received vitamin E (tocopherol nicotinate, 600 mg/day) and vitamin C (1200 mg/day) orally. Results. The hearing gain after therapy was 29.4 dB and the improvement rate was 63.3% in the study group, compared with 18.5 dB and 44.0% in the control group. Significant improvement was seen in the hearing gain and recovery rate in the study group.

Prognostic factors for squamous cell carcinoma of the temporal bone: extensive bone involvement or extensive soft tissue involvement?

Conclusion: Extensive bone erosion correlated with a worse prognosis of the squamous cell carcinoma (SCC) of the temporal bone but extensive soft tissue involvement did not correlate with prognosis in this study. Resectability of the tumor seems to be major prognostic factor of temporal bone SCC. Objective: Prognostic factors for SCC of the temporal bone were evaluated regarding initial clinical symptoms and radiographic imaging. Patients and methods: Clinical symptoms of the patients with primary SCC of the external auditory canal (EAC) or middle ear (ME) were reviewed based on medical records. Correlation of clinical symptoms and cancer severity staging using the modified Pittsburgh classification was analyzed, along with disease-specific survival (DSS). Results: Sixteen patients with primary SCC of the EAC (n=13) or ME (n=3) were included in the study population. DSS was not influenced by whether a hearing disturbance or otalgia was noted at the first medical examination. Extended bone involvement identified with imaging studies significantly correlated with worse prognosis (p<0.05). Prognoses of patients without extensive bone erosion were good, and extensive (≥0.5 cm) soft tissue involvement did not correlate with prognosis in this study. Prognoses of patients with insufficient bone resection or no surgery were significantly poor (p<0.01).

Roles of epithelial-mesenchymal transition in squamous cell carcinoma of the temporal bone.

Objectives: The authors recently demonstrated that extensive bone erosion correlated with a worse prognosis of the squamous cell carcinoma (SCC) of the temporal bone. The present objective was to investigate the expressions and the roles of epithelial-mesenchymal transition (EMT) in SCC of the temporal bone. Study Design: Retrospective patient file review and immunohistochemical study of tissues of patients with SCC of the temporal bone. Patients: The authors examined the expressions of vimentin in 16 patients with SCC of the temporal bone by immunohistochemical analysis. Results: As expected, vimentin was expressed on SCC of the temporal bone. We regard the patient who has vimentin-positive cells as EMT-positive patient because gain of vimentin is a hallmark in the EMT reported in several types of cancer. EMT positive tumors significantly correlated with extensive bone erosion, and extensive bone erosion correlated with a worse prognosis of the SCC of the temporal bone. Conclusion: The study results suggest that EMT in tumor cells becomes an important indicator of poor prognosis in SCC of the temporal bone.

Clonal spread of β-lactamase-producing amoxicillin–clavulanate-resistant (BLPACR) strains of non-typeable Haemophilus influenzae among young children attending a day care in Japan

OBJECTIVE Resistant strains of non-typeable Haemophilus influenzae (NTHi) are one of the principal causes of recurrent acute otitis media (otitis prone), rhinosinusitis, and pneumonia in young children. Beta-lactamase-nonproducing ampicillin-resistant (BLNAR) strains are particularly common in Japan, and beta-lactamase-producing amoxicillin-clavulanate resistant (BLPACR) strains are now emerging. We investigated the nasopharyngeal carriage status of these resistant strains among children attending a same day care center during a 10-year period. METHODS From 1999 to 2008, we obtained nasopharyngeal swab specimens from young children attending a same day care center and examined the incidence of resistant strains of NTHi. Antimicrobial resistance of NTHi was identified based on PCR analysis of mutation of the penicillin binding protein (PBP) genes. Pulsed-field gel electrophoresis (PFGE) was performed to examine the clonal relationship of each resistant strain. RESULTS The prevalence of resistant strains of NTHi among the children attending this day care has significantly increased during the past 10 years and most of this day care children recently have resistant strains with PBP gene mutations in their nasopharynx. Genetically BLPACR (gBLPACR) strains have rapidly increased since 2007 and PFGE analysis demonstrated that all gBLPACR were clonally identical. This is the first report of apparent clonal dissemination of gBLPACR strains of NTHi occurring in a certain environment such as day care. CONCLUSIONS The rapidly increasing prevalence of resistant strains, in particular gBLPACR, in this day care center may predict a high incidence of these resistant bacteria from clinical isolates in the near future and potential serious medical problems worldwide.

Retrograde mastoidectomy on demand with soft-wall reconstruction in pediatric cholesteatoma

Abstract Conclusion: Retrograde mastoidectomy with soft-wall reconstruction is an effective technique that can be used to lower the recurrence rate of cholesteatoma in the pediatric population. Objective: To evaluate surgical outcomes of retrograde mastoidectomy when using soft-wall reconstruction in pediatric cholesteatoma. Methods: A total of 25 children underwent cholesteatoma removal surgery employing soft-wall reconstruction. The cases were retrospectively reviewed. Average follow-up time was 48.7 months. In order to fully expose and extirpate the disease, the bony canal wall was removed in association with a retrograde-type mastoidectomy in all cases. The posterior ear canal defect was then reconstructed using soft tissue; i.e. temporal fascia and canal wall skin. The incidence and localization of residual and recurrent cholesteatoma, preoperative and postoperative audiogram results, pure-tone average (PTA), and air–bone gap (ABG) were assessed. Results: Residual cholesteatoma was detected in 5 (20%) of 25 ears while recurrent cholesteatoma occurred in 1 (4%) of 25 ears. The mean preoperative PTA of air conduction (AC) was 39.1 dB, while the preoperative PTA of the ABGs was 28.8 dB. The mean postoperative PTA-AC and PTA-ABG were 20.9 dB and 11.7 dB, respectively. The mean hearing gain was 18.2 dB. The differences between the pre- and postoperative values were statistically significant (p < 0.05).

Concurrent Superselective Intra-Arterial Chemotherapy and Radiotherapy for Late-Stage Squamous Cell Carcinoma of the Temporal Bone

Objectives: This study evaluated the efficacy of concurrent superselective intra-arterial chemotherapy and radiotherapy without surgery for late-stage squamous cell carcinoma of the temporal bone, which typically has a poor prognosis. Methods: The subjects were 5 patients treated at our hospital between 2007 and 2010 for primary cancer of the temporal bone. One patient had a stage T3 tumor, and 4 patients had T4 tumors, according to the Pittsburgh staging system. All patients received irradiation with a conventional once-daily fraction of 2 Gy, and the total dose ranged from 60 to 66 Gy. Intra-arterial cisplatin via transfemoral catheterization and intravenous sodium thiosulfate were administered. The contribution of each vessel in supplying blood to the primary tumor was determined by real-time computed tomographic angiography. Results: Three patients obtained a complete response. The same 3 patients remain alive without local recurrence (mean survival, 28 months), 1 patient died of distant metastasis without local recurrence after 19 months, and 1 patient remains alive with local recurrence. Conclusions: Although the small number of patients prevents comparisons with other treatments, the present study obtained good results. This may become an effective treatment for patients with late-stage squamous cell carcinoma of the temporal bone.

Neuroprotective effects of vitamin E on adult rat motor neurones following facial nerve avulsion.

Conclusion. The present study demonstrates the neuroprotective effect of vitamin E after peripheral facial nerve injury. Antioxidants may have therapeutic potential in traumatic facial nerve dysfunction resulting from traumatic temporal bone injury and ear surgery. Objective. We investigated the possible neuroprotective effect of vitamin E on the facial motor nucleus (FMN) motor neurones after peripheral nerve avulsion. Methods. In 36 adult rats, the right facial nerve was avulsed from the stylomastoid foramen. Following nerve avulsion, immunohistochemistry was used to investigate the effects of vitamin E on 4-hydroxynonenal (HNE) activity. FMN motor neurones and glial cells were counted bilaterally in sections stained with cresyl violet. Results. Rats administered vitamin E exhibited clear suppression of injury-induced neuronal HNE expression in the ipsilateral FMN as compared to non-treated controls. Following nerve avulsion, the number of surviving motor neurones in the ipsilateral FMN was significantly greater among vitamin E-treated rats than non-treated controls.

Efficacy of concurrent superselective intra‐arterial chemotherapy and radiotherapy for late‐stage squamous cell carcinoma of the temporal bone

radiotherapy for late-stage squamous cell carcinoma of the temporal bone Sugimoto, H.,* Hatano, M.,* Yoshida, S., Sakumoto, M., Kato, H., Ito, M. & Yoshizaki, T.* *Department of Otolaryngology-Head andNeck Surgery, KanazawaUniversity Graduate School ofMedical Science, Ishikawa Prefectural Hospital, Otolaryngology-Head and Neck Surgery, Kanazawa, Fukui Prefectural Hospital, Otolaryngology-Head and Neck Surgery, Fukui, Pediatric Otolaryngology, Jichi Children’s Medical Center Tochigi, Jichi Medical University, Shimotsuke, Japan

A case of chronic otitis media caused by Mycobacterium abscessus

Although it appears very uncommon in adult COM, Mycobacterium abscessus should be considered as a possible cause of a chronically draining ear. Multi-antibiotic chemotherapy including high-dose clarithromycin can effectively treat adult COM cased by M. abscessus. The first case report of adult chronic otitis media (COM) caused by M. abscessus is described here. A 61-year-old woman presented persistent otorrhea for 2 months, despite treatment with standard antimicrobial drugs. Physical examination revealed a small perforation of the tympanic membrane and edematous middle ear mucosa. Mycobacterial cultures and PCR yielded non-tuberculous mycobacteria (NTM); M. abscessus. Intravenous panipenem/betamipron and amikacin and oral clarithromycin were administered for 36 days. Computed tomography of the temporal bone showed improved aeration in the tympanic cavity, but soft tissue shadow remained unchanged in the mastoid 31 days after starting medication. She therefore underwent tympano-mastoidectomy at 36 days. At surgery, inflammation remained in the middle ear, and edematous pale mucosal tissue was noted around the stapes and ossicular chain. Histopathologic examination showed inflammation and granulation tissue, but no caseating necrosis or acid-fast bacilli. After surgery the symptoms resolved and remained well without evidence of infection recurrence 12 months after the operation.

Changes in calbindin-D28k and parvalbumin expression in the superior olivary complex following unilateral cochlear ablation in neonatal rats.

Conclusion. Unilateral congenital deafness with a volume reduction in cochlear nucleus (CN) induced changes in the calcium-binding proteins (CaBPs) in the contralateral superior olivary complex (SOC) in the rat. With the loss of neurons and a volume reduction in the CN, a decrease in the input to the contralateral SOC may occur, which results in the down-regulation of CaBPs in these nuclei. This study may provide some implications regarding the neurochemistry in the auditory brainstem of deaf children. Objective. Hearing loss produced by cochlear damage during early development can result in persistent changes in the organization of the central auditory system in adults. The purpose of the present study was to investigate the neurochemical changes produced in the auditory brainstem of rats with unilateral cochlear ablation conducted before the onset of hearing. Materials and methods. Following unilateral cochlear ablation during early development, we examined the changes in the distribution of two CaBPs, calbindin-D28k (CB) and parvalbumin (PV), in the SOC. Results. Upon reaching adulthood, a marked decrease in CB- and PV-immunoreactive neurons was observed in the contralateral SOC, particularly in the medial nucleus of the trapezoid body (MNTB), although no neuronal cell death was observed. A volume reduction in the ipsilateral CN was also observed.