Teruhiro Ogawa

Volume Quantification of Healthy Paranasal Cavity by Three-Dimensional CT Imaging

The volume of the air cavities in the paranasal sinuses is, even at present, not only the simplest but also the most important index employed in the evaluation of the paranasal sinus. We have measured the size of the paranasal cavities in 20 healthy Japanese subjects by reconstructing three-dimensional (3-D) computed tomography (CT) images. To avoid any bias in determining the cavity margin, we first measured bilateral maxillary sinuses of a macaque both by silicone injection and by 3-D reconstruction. Then the CT value for 3-D reconstruction was determined by comparison with the volume measured by direct injection. Each sinus of the healthy volunteers was then measured by 3-D reconstruction imaging. Paranasal sinuses were, individually and on the whole, apparently larger than previously reported: 90.1 ml in males and 72.5 ml in females, on average. Comparing with other body size indices, the increment of the size was quite apparent and the lower prevalence of sinusitis was assumed to play a role in this increased volume of paranasal sinuses in the modern Japanese population.

Laryngeal zoster with unilateral laryngeal paralysis

The case of a 60-year-old man with a unilateral laryngeal mucosal lesion and complete left vocal cord paralysis is reported. The lesion localized to the left side of the larynx covered the laryngeal vestibule, arytenoid, false vocal cord and true vocal cord, but did not extend to the hypopharynx or oropharynx. Enzyme immunoassay for varicella-zoster virus (VZV) led to a diagnosis of VZV infection.

Ménière's disease in childhood

We report 3 rare cases of Ménières disease in children. In Case 1 and 3, vertigo, hearing loss and tinnitus recovered soon after medical therapy. In Case 2, however, vertigo recurred and the hearing level on the right side markedly deteriorated. The equal-loudness contours on three-dimensional audiogram showed that right-sided aggravated hearing loss fluctuated for 4 years at middle-and low-frequencies despite medication. Finally intratympanic injection of gentamicin sulfate was performed. The patient has had no definitive spell of vertigo after gentamicin therapy. At our department, the incidence of Ménières disease in pediatric patients with vertigo was 2.9%.

Hypophysis surgery with or without endoscopy

OBJECTIVE Hardys operation with microscope has long been the standard method for pituitary adenoma. But a new approach via the nasal cavity using an endoscope has been adopted recently. In this study, the postoperative outcome as well as the preoperative evaluation of endoscopic hypophysectomy and non-endoscopic one were compared at our faculty. METHOD We performed the non-endoscopic transnasal hypophysectomy on 18 patients and the endoscopic transnasal hypophysectomy on thirteen patients who had a pituitary lesions from February 1996 to October 1999. As to these patients the situations from preoperation through postoperation such as chief complaints, serum hormone level, final diagnosis, tumor size, as well as operating time or blood loss during the operation were discussed precisely. Then the merits and demerits of endoscopic hypophysectomy were discussed. RESULT Five PRL-producing adenoma, three GH-producing adenoma, nine non-functioning adenoma, and two ACTH or TSH-producing adenoma were included in this discussion as endoscopic group. The age of non-endoscopic group are from 23 to 73 (49.4 in average), and they include ten males and eight females. On the other hand three PRL-producing adenoma, two GH-producing adenoma, two non-functioning adenoma, and one Rathkes cyst were included in this discussion as endoscopic group. The age of endoscopic group are from 19 to 73 (49.1 in average), and they include seven males and six females. As to non-endopscopic group the blood loss during each operation is 568 ml and operating time is 256 min in average. For endoscopic group the blood loss is 296 ml and operating time is 234 min in average. CONCLUSION By microsurgery in the pituitary operation with endoscopy, the minimal invasive surgery becomes possible by reducing blood loss and shortening operating time. During the operation cooperation between neurosurgeon and ENT surgeon is indispensable in order to perform hypophysectomy smoothly. The development of optical better aids and operation instruments for endonasal hypophysectomy is desired in the future. The navigation system was more useful than X-ray fluoroscopy to obtain the detailed information.

Expression of costimulatory CD80/CD86-CD28/CD152 molecules in nasal mucosa of patients with perennial allergic rhinitis

Background B7 molecules (CD80, CD86) and their counter‐receptors, CD28 and CD152 (CTLA‐4), play an important role in T cell‐mediated immune responses. We previously demonstrated that B7 molecules are selectively up‐regulated not only on B cells but also on T cells from the peripheral blood mononuclear cells of patients with perennial rhinitis cultured with allergen. However, the expression of CD80/CD86 molecules and their counter‐receptors in nasal mucosa, the actual inflammatory site of allergic rhinitis, has not yet been clarified.

Olfactory dysfunction in head injured workers.

Olfactory dysfunction following trauma has been widely reported and is currently compensable according to existing American Medical Association guidelines when it occurs in the occupational setting. Its presence and the risk factors for its development, however, have not been clearly delineated in occupationally head injured workers. In order to assess this phenomenon, a series of 365 consecutive head injured workers from 1993-1997 was assessed in order to determine the incidence of post-traumatic olfactory dysfunction and its association with the severity of the head injury, the mechanism of injury and other neurotological abnormalities in the same cohort group. Olfactory dysfunction was identified in 13.7% (9.3% with anosmia, 4.4% with hyposmia/dysosmia). It was more likely where the loss of consciousness > 1 h (p < 0.002), in more severe head injuries (grades II-V) (p < 0.001) and when skull fracture (p < 0.001) occurred. The direction of the blow applied to the skull did not influence its presence, although radiologically confirmed skull fractures in the frontal, occipital, skull base and midface were twice as likely as temporal and parietal fractures to result in an olfactory change. From a neurotologic perspective, approximately 21.9% of head injured workers were determined to have recognizable evidence of cochleovestibular dysfunction. Olfactory dysfunction as a physical finding post-head injury compares favourably with the presence of post-traumatic benign positional paroxysmal vertigo (BPPV) and its atypical variants in 11.2% of head injured workers.

Histological reaction to hydroxyapatite in the middle ear of rats

OBJECTIVE Present study was performed to evaluate the histological response of rat middle ear mucosa following implantation of Apaceram granules, a synthetic dense hydroxyapatite [Ca10(PO4)6(OH)2], prepared from commercially available synthetic auditory ossicle, and to assess the precise histological response of the rat middle ear to implantation of Apaceram granules, by microscopic examination of mucosal tissue at various time points after implantation. METHODS Apaceram granules were implanted in the temporal bulla of 32 rats. As control, sham surgery was performed in a group of ten rats. Bulla specimens were removed at 1, 3, 7, 14, and 30 days after surgery in the implant and control groups, and at 90, 180 and 300 days in the implant group. Specimens were decalcified, sectioned at a thickness of 6 microm, and stained with haematoxylin and eosin, and Mallorys azan for histological examination of mucosal tissue. RESULTS Evidence of inflammatory reaction was slightly greater in the implant group than in controls. Lymphocyte and macrophage counts were higher in the implant group 1 day after surgery, but decreased to similar levels by day 3, and continued to decrease thereafter, and few were observed in the implant group at 300 days. Neutrophils observed at 1 day after surgery were not evident in either group at 3 days. Gradual fibrosis development continued in both groups over all time points studied. Foreign body giant cells were never observed in either group. No bony reaction was observed in any specimen. CONCLUSION The results of this study suggest that Apaceram is biocompatible and suitable for reconstructive ear surgery.

Osteoma with cholesteatoma in the external auditory canal

We report an unusual case of a 13-year-old girl with a benign osteoma associated with a cholesteatoma in the external auditory canal and serous otitis media. The osteoma was located in the antero-inferior wall of the right external auditory canal. A cholesteatoma was present between the osteoma and the tympanic membrane. Computed tomography revealed a soft tissue density within the external auditory canal and in the middle ear cleft. The shadow in the middle ear cleft was considered to represent the serous otitis media. Surgical removal of the osteoma and cholesteatoma proved successful, and no recurrences or complications have occurred in the first year postoperatively.

Presence and characterization of sensitization to staphylococcal enterotoxins in patients with allergic rhinitis.

Exotoxins derived from Staphylococcus aureus appear to be involved in the pathogenesis of allergic diseases, especially atopic dermatitis (AD). However, little is known about sensitization to enterotoxins in cases of respiratory allergies. Because the nasal cavity is a primary site of colonization by S. aureus, we sought to determine the prevalence and role of serum immunoglobulin E (IgE) antibodies against staphylococcal enterotoxin A (SEA) and SEB in patients with allergic rhinitis (AR). The presence of SEA- and SEB-specific IgE was determined in 40 patients with AR and 16 healthy control subjects. In the rhinitis group, nasal symptom score, total serum IgE, sensitization to other inhaled allergens and the presence of sinusitis were determined. Twenty-five percent of patients with AR were sensitized to SEA/SEB whereas 6.3% of controls were sensitized to the toxins. Sensitization to SEB was predominant relative to SEA. There were no significant differences in the severity of nasal symptoms and complications of other allergic diseases including AD and bronchial asthma, between patients with or without sensitization to SEA/SEB. However, patients sensitized to these toxins were likely to show increased total serum IgE and polyvalent sensitization, suggesting that exposure and subsequent sensitization to SEA/SEB may be involved in polyvalent sensitization.

A terminal deletion of the short arm of chromosome 3: karyotype 46, XY, del (3) (p25-pter); a case report and literature review

We describe a boy with a deletion of the short arm of chromosome 3; (46, XY, del (3) (p25-pter) who presented several minor craniofacial anomalies at birth. Only 34 cases of small distal 3p deletion have been described in the literature, seven of them showed hearing loss and four of the 34 cases had brain anomalies. But in none of the 34 cases the middle and internal ear were radiographically examined. Despite the severe hearing loss detected by auditory brainstem evoked responses (ABR), computerized tomographic scanning (CT-scan) of the ear showed a normal anatomy in this patient. The head CT-scan and magnetic resonance imaging (MRI) disclosed a hypoplastic corpus callosum and an enlargement of the lateral ventricles.