Tadahiko Saiki

Implantable Hearing Aid Using a Piezoelectric Ossicular Vibrator: A Speech Audiometric Study

The speech discrimination provided by a piezoelectric implantable hearing aid (IHA) was compared to that by a conventional hearing aid (CHA) using speech audiometric studies in seven patients. Recognition of monosyllabic and bisyllabic words was measured using word lists recorded on a compact disc with and without background noise. the intensity of speech sound was 65 dB SPL, while that of background noises varied from 65 to 75 dB SPL. The ear canal opposite the test ear was closed with a clay mold to avoid perception of the test sound through the contralateral ear. On monosyllabic test without noise, speech discrimination scores by the IHA and the CHA showed no significant difference. However, with noise of 65 dB SPL, the IHA outperformed the CHA. When the intensity of the noise increased to 70 or 75 dB SPL, the scores by both devices decreased, but a significant difference was noted between the two. On the bisyllabic test, the results were almost identical with those on the monosyllabic test. These findings indicate that speech recognition by the IHA was superior to that by CHA under noisy circumstances.

Extraskeletal Chondroma of the Preauricular Region: A Case Report and Literature Review

An extraskeletal chondroma is a rare benign cartilaginous tumor that develops in soft tissue. Histologically, it is a lobulated nodule surrounded by a fibrous capsule; the inside consists of mature hyaline cartilage containing a few normal chondrocytes. We present a rare case of extraskeletal chondroma in the preauricular region. A 43-year-old man presented with a 2-cm-diameter right preauricular tumor that had been developing for 1 year. Magnetic resonance imaging showed a solid lobulated tumor in the right preauricular region, which was proximate to the capsule of the right temporomandibular joint (TMJ). This was subsequently resected under general anesthesia. The tumor was not in contact with the TMJ capsule and had not invaded the surrounding tissue, facilitating en bloc excision. Histopathologically, the tumor comprised mainly of hyaline cartilage containing chondrocytes with chondrocytic lacunae and was diagnosed as a chondroma. The postoperative period was uneventful, and there was no evidence of recurrence at the 2-year followup. We describe the clinical characteristics of our case and review the literature, emphasizing the differential diagnosis.

Laryngeal Giant Cell Tumor: A Case Report and Review of the Literature

Giant cell tumor (GCT) is a benign neoplasm arising most commonly in the long bones. GCTs of the larynx (GCTL) are relatively rare, and only individual case reports are documented in the literature. Patients with such tumors may present with hoarseness and anterior neck swelling. We present a 59-year-old man with hoarseness and enlarging anterior neck mass for 3 months. A fiberscopy revealed a submucosal swelling of the left subglottic trachea. Computed tomography and magnetic resonance imaging of the larynx demonstrated a large, well-defined, inhomogeneous enhancing mass at the left thyroid cartilage, which was obstructed entirely. The anterior neck mass was biopsied for histopathological analysis, which showed multinodularity with intervening vascularized connective tissues. The mass was made up of mononuclear cells and distributed multinucleated giant cells. The mitotic activity of the mononuclear cells was as high as 6 per 10 high-power fields. Pathologic consultation resulted in a diagnosis of giant cell tumor. The patient underwent total laryngectomy and, postoperatively, he did well without recurrence or metastasis for two and a half years.

Chronic otitis media and tympanoplasty in aged patients.

Results of tympanoplasty in patients over 60 years old were analyzed mainly in terms of hearing and postoperative course. Tympanoplasty was carried out in 78 ears of 67 patients during the last ten years. The following types of tympanoplasty were employed: type I in 34 ears, type III-Columella in 23 ears, type IV-Columella in 13 ears, and other types in 8 ears. The results were compared to those of 145 ears from 119 patients ranging from 20 to 59 years of age who had undergone tympanoplasty during the last 3 years. In tympanoplasty type I, closure of the air-bone gap within 20 dB was attained in 70% of the patients over 60 years old, 90% in the 50-59 year age group, and 100% in the 20-49 year age group. In type III-Columella, these values were 60, 78, and 94%, respectively. During the postoperative follow-up, perforation of the eardrum recurred in 5 of 78 ears (6.4%) in the patients over 60, in 5 of 52 ears (9.6%) in the 50-59 year group, and in 7 of 93 ears (7.5%) in the 20-49 year group. These results suggested that hearing results were worse in patients over 60 than in the other age groups, even though the incidence of graft failure did not greatly differ by age.

Implantable Hearing Aid in Fourteen Patients with Mixed Deafness

An implantable hearing aid (IHA) in which the stapes was directly driven by a ceramic vibrator of bimorph design was applied to fourteen patients with mixed deafness of varying degree due to chronic otitis media. In the partial IHA system, only the output transducer and secondary coil are implanted, the remainder of the components such as microphone, amplifier, battery and primary induction coil remain in the location behind the auricle. The vibrator was activated by an electric signal transmitted electromagnetically through the induction system from the outer unit. All the patients admitted that sound quality provided by the IHA was natural, clear and easy to hear without causing fatigue in long-term use. Speech discrimination test under noise circumstance showed that acoustic perception by the IHA was superior to that by a conventional hearing aid. In four patients, however, the implanted unit was replaced with a new one due to recurrence of cholesteatoma, head trauma, and accidental disruption of wire by manipulating the ear canal. They regained good hearing after re-implantation.

Clinical Observation of the Paranasal Sinus Mycosis.

The authors reported 30 cases of paranasal sinus mycosis treated at Uwajima Municipal Hospital between 1989 and 1994. These 30 patients (7 males and 23 females) ranged in age from 34 to 74 years old with a mean of 55.2. The most common chief complaint was rhinorrhea, nasal obstruction and cheek pain. The disease was unilateral in 29 cases and bilateral in one case. The original lesion of the mycosis was the maxillary sinus in 29 cases and the frontal sinus in one case. In 25 cases, high density areas similar to calcification were seen in the maxillary sinus and in 11 cases, bone destruction was detected in the medial wall of the maxillary sinus by CT scan. A diagnosis of mycosis was mainly confirmed by pathological examination. In one case, the authors found actinomycosis, while the remaining cases showed aspergillus. Surgical procedures were performed in all cases. Of 30 cases, 22 were treated by Caldwell-Lucs procedure, 7 cases by endoscopic endonasal sinus surgery and one case by Killians technique and craniosurgery, respectively. Prognosis was good in all cases.

Neck Lymphadenopathy due to Relatively Uncommon Benign Disease Entities. Cat Scratch Disease and Castleman's Lymphoma.

We examined and treated two patients with neck lymphadenopathy due to two different relatively uncommon diseases: cat scratch disease and Castlemans lymphoma. The swollen lymphnodes of the former were under the left auricle and those of the latter were in the left posterior cervical region. Detailed anamnesis and pathological examination of open biopsy specimens were useful for making the diagnosis. The clinical courses of both patients were uneventful.

Otitis media with effusion in routine medical examinations of one and a half-year-old children. Follow-up studies.

During the past 4.5 years screening tests using tympanometry (TM) for otitis media with effusion (OME) were performed as part of the routine medical examination of 13, 315 children at one and a half-years of age in Matsuyama City.1) In the first screening, B or C type TM was recorded in 3, 969 of the 13, 315 children (29.8%).2) In the second screening, B or C type TM was found in 1, 475 of the 3, 969 children (11.1%).3) In the third screening, 1, 067 (1, 804 ears) of the 1, 475 children could be followed in detail at the Ehime Prefectural Rehabilitation Center for the Physically Handicapped.4) In 1, 015 of the 1, 804 ears, B or C type TM was noted at the first examination in the center.5) Examinations were performed without treatment on 534 of the 1, 015 ears (52.6%). TM and ear drum abnormalities returned normal spontaneously in 526 of the 534 ears (51.8%).6) 481 of the 1, 015 ears (47.4%) were treated in the offices of other otorhinolaryngists. The TM and ear drum findings were later restored to normal in 393 of the 481 ears (38.7%).7) In the children who were followed for longer than three years, TM and ear drum findings were restored to normal within six months in 65.0%. However, 7.6% of those children have not yet been cured.