Nobuaki Hiraki

Relationships Among Nasal Obstruction, Daytime Sleepiness, and Quality of Life

Objectives: There has been growing awareness that nasal obstruction may impair various daily and social activities. We performed a questionnaire survey on a working population to clarify the relationships among nasal obstruction, daytime sleepiness, and quality of life (QOL).

Chronic nasal obstruction causes daytime sleepiness and decreased quality of life even in the absence of snoring.

Background There has been a growing awareness that nasal obstruction may impair various daily and social activities. We performed a questionnaire survey in a working population to clarify the contribution made by snoring concomitant with nasal obstruction to daytime sleepiness and quality of life (QOL). Methods Seven thousand nine hundred eighty daytime workers were asked to complete questionnaires, 7702 responded, and the data from 3442 subjects were finally analyzed. Nasal obstruction and snoring were graded into three and four categories, respectively. Daytime sleepiness and QOL were assessed by the Epworth Sleepiness Scale (ESS) and the Medical Outcomes Study 36-Item Short-Form Health Survey, respectively. Results Subjects with chronic nasal obstruction, even if snoring was absent, reported significantly higher ESS scores and lower QOL scores than control subjects, and the presence of habitual snoring had an additive influence on these changes. The ESS and mental QOL scores adjusted for age, sex, and body mass index showed the same tendency. Conclusion Induction of sleep-disordered breathing (SDB) is a possible cause of excessive daytime sleepiness and impaired QOL in subjects with nasal obstruction. A variant of SDB such as silent upper respiratory resistance syndrome may participate in this phenomenon in the absence of snoring.

Snoring, Daytime Sleepiness, and Nasal Obstruction With or Without Allergic Rhinitis

OBJECTIVE To investigate the relationships among nasal obstruction (NO), snoring, and excessive daytime sleepiness (EDS) in working people with or without allergic rhinitis (AR). DESIGN Prospective study using questionnaires. SETTING An industrial company in Japan. PARTICIPANTS We asked 1878 daytime workers to complete questionnaires; data from 1459 respondents were analyzed. Participants were divided into 3 groups: those with NO plus AR, those with NO without AR, and those with AR without NO. Individuals without NO or AR served as controls. MAIN OUTCOME MEASURES Allergic rhinitis and daytime sleepiness were evaluated using the European Community Respiratory Health Survey questionnaire and the Epworth Sleepiness Scale, respectively. RESULTS The percentage of snorers, the Epworth Sleepiness Scale score, and the percentage of participants with EDS were higher in the NO-AR and NO groups but were not significantly different in the AR group compared with the control group. These variables did not differ between the NO-AR and NO groups. Patients in the NO-AR and NO groups had higher odds of snoring and of having EDS, whereas the odds of snoring or of having EDS were not statistically significant in the AR group compared with the control group (P = .67 and P = .3, respectively). CONCLUSIONS Nasal obstruction is associated with snoring and EDS in individuals with or without AR. Allergic rhinitis without NO is not associated with sleep-disordered breathing or EDS.

Prediction of hearing outcomes by distortion product otoacoustic emissions in patients with idiopathic sudden sensorineural hearing loss

OBJECTIVE To investigate whether distortion product otoacoustic emissions (DPOAEs) can be a prognostic indicator of hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS Seventy-eight consecutive patients with ISSNHL were enrolled. DPOAEs were measured at the first hospital visit. Two primary pure tones with a frequency ratio (f2/f1) of 1.2 were used at non-equal sound pressure levels (L1/L2=80/70dB SPL). The DPOAE amplitude was measured at the 11 frequencies of 2f1-f2 with f2 varying from 593 to 6031Hz. All the patients received steroid administration in combination with hyperbaric oxygen (HBO) therapy. Hearing recovery was evaluated by the improvement in hearing compared to the unaffected contralateral ear. Correlations between the hearing improvement rate and five potential prognostic factors (the DPOAE amplitude, patients age, days from onset to the start of treatment, initial hearing level, and presence of vertigo) were examined by simple and multiple regression analyses. RESULTS The net DPOAE amplitude in patients with hearing improvement rate ≥50% was significantly larger than that with hearing improvement rate <50% at f2 frequencies of 3031 and 4812Hz (unpaired Students t-test, p<0.05). A simple regression analysis showed that the hearing improvement rate significantly correlated with the net DPOAE amplitude at f2 frequencies of 3031 and 4812Hz, but not with that at the other f2 frequencies tested. The correlation coefficients were 0.528 and 0.522 for 3031 and 4812Hz, respectively, with p values <1×10(-6). In a multiple regression analysis, the partial correlation coefficients of the net DPOAE amplitude were 0.308 and 0.246 with p values of 0.008 and 0.036 for 3031 and 4812Hz, respectively. CONCLUSION The significant correlation between hearing recovery and DPOAEs measured before treatment indicates that DPOAEs are a potentially useful means of predicting hearing prognosis in ISSNHL.

Clinical features of head and neck cancer patients with methicillin-resistant Staphylococcus aureus

Conclusions. The risk factors for methicillin-resistant Staphylococcus aureus (MRSA) detection in head and neck cancer patients are the duration of hospitalization, intravenous hyperalimentation, prior antibiotic use, and the coexistence of other pathogens. Objectives. To shed light on the clinical characteristics of MRSA-positive inpatients with head and neck cancers. The secondary goal was to evaluate risk factors for MRSA detection in comparison with methicillin-sensitive S. aureus (MSSA). Patients and methods. Sixty-one consecutive inpatients with head and neck cancers with S. aureus detection were analyzed based on their medical records. The antimicrobial susceptibility of isolated S. aureus was tested by the broth microdilution method. Results. MRSA and MSSA were detected in 46 (75.4%) and 15 (24.6%) of the 61 patients, respectively. There was no significant difference in the male/female ratio, age, primary site, comorbidity, cancer stage, cancer treatment, or 5-year survival rate between the MRSA and MSSA groups. Compared with the MSSA group, the MRSA group had significantly longer hospitalization periods and intervals between admission and MRSA detection, as well as significantly greater likelihood of intravenous hyperalimentation, prior antibiotic use, and co-isolation of other pathogens. Isolated strains of MRSA were thoroughly sensitive to vancomycin and arbekacin and moderately sensitive to minocycline.

Relationships between nasal obstruction, observed apnea, and daytime sleepiness.

Objective We administered a questionnaire survey to a working population in an attempt to clarify the relationships between self-reported nasal obstruction, observed apnea during sleep, and daytime sleepiness. Study Design A total of 7980 daytime workers were asked to complete questionnaires about nasal obstruction, apnea during sleep, and daytime sleepiness. Of the 7702 responses, the data from 4818 subjects were analyzed. Nasal obstruction and observed apnea were graded into 3 categories. Daytime sleepiness was assessed by the Epworth Sleepiness Scale. Results Subjects with chronic nasal obstruction had 5.22 and 2.17 times higher odds for having habitual observed apnea and excessive daytime sleepiness (EDS), respectively, compared with those without nasal obstruction (P < 0.001). After adjusting for 3 potential confounding factors (age, sex, and body mass index) and the presence of habitual observed apnea, odds ratios for having EDS decreased, but still remained significant. Conclusion Nasal obstruction is likely to cause daytime sleepiness, at least in part, by causing sleep-disordered breathing including apnea during sleep.

Immunoreactivities for glutathione S-transferases and glutathione peroxidase in the lateral wall of pigmented and albino guinea pig cochlea

Dark-skinned people are known to be more tolerant of ototraumatic noise than are light-skinned people, and pigmented animals are more tolerant of ototraumatic noise and aminoglycoside ototoxicity than are albino animals. Such tolerance may be dependent on the local ability of detoxification and antioxidant enzymes, including glutathione S-transferase (GST) and glutathione peroxidase (GSPx). In the present study, we examined the difference in GST/GSPx expression in the lateral wall of the cochlea between pigmented and albino guinea pigs. Eight-week-old male pigmented and albino guinea pigs were killed by transcardiac perfusion with 2% paraformaldehyde. The cochlear ducts were isolated, further fixed with 4% paraformaldehyde, decalcified, and then embedded in paraffin. Sections prepared at 5-μm thickness were incubated with anti-GST-α,-μ,-π, or anti-GSPx antibody, reacted with Alexa Fluorconjugated secondary antibody, and examined under a Carl Zeiss Axioskop 2 plus fluorescence microscope. The cochlea ducts were also subjected to immunoelectron microscopy for GST-π by the postembedment method. The stria vascularis of pigmented guinea pigs was strongly immunoreactive for GST-α,-μ,-π, and GSPx, whereas no or only weak immunoreactivities were seen in the stria vascularis of albino guinea pigs. The spiral ligament showed positive but different immunoreactivities for these enzymes between the strains. Double-stained immunofluorescence micrographs for GST-π and GSPx showed a close resemblance of localization between the two enzymes in both pigmented and albino guinea pigs. At the ultrastructural level, immunoreactivity for GST-π was localized preferentially in the melanin cells of pigmented guinea pigs. These results suggest that correlation between pigmentation and inner ear susceptibility is, at least partially, attributed to the different distribution of GST/GSPx in the stria vascularis.

Digastric Muscle Sew-up Procedure for the Repair of the Floor of the Mouth following Pull-through Operation for Oral Cancers

Objectives: We report the digastric muscle sew-up procedure for the repair of the floor of the mouth following the pull-through operation for advanced oral cancers. Methods: Eleven patients with advanced oral cancers (of the tongue in 8 cases and of the floor of the mouth in 3 cases) were retrospectively analyzed. One-third glossectomy and hemiglossectomy were performed in 4 patients each; the other 3 patients underwent tumor resection on the floor of the mouth. After neck dissection and tumor resection via the pull-through approach, the floor of the mouth was repaired simply by sewing the digastric muscle to the mandibular base. The surfaces of the transected musculature of the tongue and the floor of the mouth were left uncovered and exposed to the oral cavity. Results: The postoperative wound healing was fairly good in all of the patients. Neck infection or the formation of a fistula on the floor of the mouth was not seen. The patients started transoral ingestion by the 10th postoperative day. Temporary difficulty in swallowing occurred in all patients, but was totally alleviated within 1 month. Their clarity of speech recovered to a tolerable level. Conclusions: We believe that the digastric muscle sew-up procedure is a simple, safe, and timesaving method for the repair of small to medium-sized defects of the floor of the mouth created by ablative surgery in patients with advanced oral cancers.

Hyperbaric Oxygen in Combination with Other Therapies for Idiopathic Sudden Sensorineural Hearing Loss

Hyperbaric oxygen (HBO) therapy combined with steroid administration is an effective treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), but is sometimes unfeasible for patients with underlying diseases, particularly for those with steroid-intolerance. We conducted a controlled retrospective analysis of patients with ISSNHL who received HBO in combination with stellate ganglion block (SGB), prostaglandin (PG) E1, or steroid therapy in order to identify possible alternative regimens.Three hundred and six consecutive patients with ISSNHL (average hearing levels of 5 frequencies (250-4000Hz)≥40dB; time from the onset of hearing loss to the start of treatment ≤30 days) were enrolled. One hundred and ten, 95, and 101 patients underwent SGB+HBO (SGB group), PGE1+HBO (PG group), and steroid+HBO therapy (steroid group), respectively. Hearing recovery was evaluated by grade assessment, by hearing gain, and by hearing improvement rate compared to the unaffected contralateral ear.The overall hearing outcome did not differ among the three groups. In patients with initial hearing levels <80dB, the PG group tended to show a higher cure rate, recovery rate, hearing gain, and hearing improvement rate compared to those of the other groups. In contrast, in patients with initial hearing levels ≥80dB, the SGB group tended to show a higher recovery rate, hearing gain, and hearing improvement rate compared to those of the other groups, and the hearing improvement rate was significantly higher in the SGB group than in the PG group (53.0±5.0% vs. 35.3±6.8%; p<0.05).We concluded that both SGB+HBO and PGE1+HBO are promising alternative regimens for ISSNHL, and that SGB+HBO and PGE1+HBO are recommended for patients with initial hearing levels≥80dB and <80dB, respectively.