Rie Tochino

Disregard of cholesteatoma in congenital aural stenosis

Congenital aural stenosis (CAS) is one type of congenital aural atresia (CAA) and is assumed to be a relatively mild type. Although CAS may be associated with cholesteatoma in the external ear canal, little attention has been paid to this association. We present two cases of CAS with middle ear infection due to destructive cholesteatoma. Both had been followed for microtia by a plastic surgeon. These patients had already exhibited cholesteatoma on CT examination, although it had been missed before the emergence of ear symptoms, otorrhea, and otalgia. We present our cases with successive changes in CT findings over time and discuss the problems of CAS with cholesteatoma.

Positional and positioning nystagmus in healthy subjects under videonystagmoscopy.

Objective The eye-focused video camera as sensitive to infrared light is very useful for detecting nystagmus with open eyes in the dark. The existence of physiological nystagmus has been reported. We investigated how frequently physiological positional and positioning nystagmus is seen in healthy individuals under infrared video goggles. Materials and methods Eighty-nine healthy individuals were examined in this study. Positional and positioning nystagmus was examined with infrared video goggles. Results Positional nystagmus could be detected in 65 of the 89 subjects under infrared video goggles. The majority of nystagmus was horizontal nystagmus, and vertical nystagmus was also seen in four subjects. Nystagmus was most frequently recognized in right or left shoulder down position. Positioning nystagmus was detected in 40 subjects. Conclusions Positional and positioning nystagmus frequently exist in healthy subjects. This finding means that the existence of physiological nystagmus must be considered when diagnosing dizzy patients using this equipment.

Effects of cigarettes and alcohol consumption in benign paroxysmal positioning vertigo

Conclusion. Smoking was associated with a lower incidence of benign paroxysmal positioning vertigo (BPPV). A larger study is required to establish the role of smoking in BPPV. Objective. To evaluate the effect of cigarette and alcohol consumption on BPPV. Patients and methods. One hundred and fifty-six patients with BPPV and 155 age- and sex-matched normal subjects were compared according to their cigarette and alcohol consumption. Patients with BPPV who had had a recurrence of the disease and those who had not were also compared as to their cigarette and alcohol consumption. The question of whether the length of time until recovery was influenced by cigarette or alcohol consumption was also investigated. Results. Control subjects smoked significantly more often than BPPV patients, and patients without recurrence more frequently than patients with recurrence. Alcohol consumption was also more common in control subjects than in BPPV patients, but there was no difference between patients with recurrence and without recurrence. There was a tendency for smoking patients to recover sooner than non-smoking patients. Alcohol consumption did not affect the length of time until recovery.

Fibrous Dysplasia of the Temporal Bone with Cholesteatoma

Fibrous dysplasia is an uncommon benign bone disorder of unknown origin. It rarely affects the temporal bone. We report a case of fibrous dysplasia of the temporal bone with cholesteatoma in the external auditory canal, the first complaint of which was left otorrhea. Fibrous dysplasia invaded the external ear canal, stenosis of which causes a cholesteatoma. Mastoidectomy, tympanoplasty, and meatoplasty were perfomed. We discuss the characteristics of this condition, its differential diagnosis and its treatment.

Application of Modified Transmastoid Approach Methods to Congenital Atresia of the External Ear Canal with Middle Ear Infection

Objective To present our surgical technique for congenital atresia of the external ear canal with middle ear infection. Methods A modified transmastoid approach to congenital atresia of the external ear canal with middle ear infection was applied. Our method is to visualize the landmarks of the mastoid cavity such as the antrum, sinodural angle and digastric ridge by the canal-open method to avoid facial nerve injury and then prepare a relatively large external ear canal with reconstruction of the posterior wall of the external ear canal. Results and Conclusion This method is suitable not only for treating congenital atresia of the external ear canal with middle ear infection, but also for avoiding facial nerve injury and postoperative complications such as re-stenosis of the new ear canal and postoperative middle ear infection.

Congenital External Auditory Canal Stenosis: A Serious Disease Leading to Destruction of the Mastoid Cavity-Its Diagnosis and Treatment-

Congenital external auditory canal stenosis (CAS) is usually considered one of the slight malformations related to congenital external auditory canal atresia (CAA). However, the clinical symptoms caused by the slight malformation may not be mild. Destructive external ear canal cholesteatoma commonly occurs in CAS, but is infreguent in CAA. For several reasons CAS tends to receive an inappropriately low estimate of risk compared to that for CAA. The other malformations accompanying CAS and CAA such as microtia confound the decision regarding future treatment for doctors as well as for the patients themselves. A consensus regarding the clinical entity of CAS is required among doctors not only in otorhinolaryngology but also in relevant fields such as pediatrics and plastic surgery. These two malformations, the pathological conditions and clinical treatment of CAS and CAA should be considered separately.