Tetsu Iwanaga

Effect of a large-sized silicone sheet upon recovery of mastoid aeration after mastoidectomy

Objective To evaluate the effect of our large-sized silicone sheet upon postoperative recovery of mastoid aeration in ears after surgery including mastoidectomy and soft-wall reconstruction (SWR). Study Design and Setting Retrospective chart review in a tertiary care center. Subjects and Methods Recovery of mastoid aeration was assessed by CT 4 to 12 months after surgery on 72 ears (69 patients), in which the silicone sheet covering from the eustachian tube (ET) to the mastoid was placed after SWR procedure with mastoidectomy were done for their chronic otitis media. Results were compared with those with a small silicone sheet. Results Recovery of mastoid aeration was significantly better in the large-silicone-sheet group than in the small-silicone-sheet group (X 2 value = 11.7146, P = 0.0006). Conclusion This preliminary study suggested that our large-sized silicone sheet may be effective for postoperative recovery of mastoid aeration even in ears operated with SWR procedure.

Influence of topical application of basic fibroblast growth factor upon inner ear

Background Basic fibroblast growth factor (b-FGF) has recently been shown to have a positive effect on the treatment of postoperative mastoid cavity problem, but its ototoxicity has not been investigated. Objective To investigate the effect of b-FGF on the inner ear of guinea pigs. Study Design and Setting In groups A (n = 10) and B (n =11), b-FGF was applied into the left external auditory canal and the middle ear, respectively. The right ear served as a control. At 1 week after b-FGF administration, the endocochlear DC potential (EP) was measured, and morphology of the cochleae was examined by scanning electron microscopy. Results In group A, the EP values of experimental ears and controls were 90.0 ± 8.4 (mV, mean ± SD) and 89.4 ± 4.3 (P < 0.05). In group B, the values were 86.5 ± 11.4 and 87.5 ± 6.1, respectively, (P < 0.05). Morphological findings showed no damage on the cochlear. Conclusion Application of b-FGF to the external and middle ears does not seem to have an apparent risk of ototoxicity.

Does topical application of 5-fluorouracil ointment influence inner ear function?

OBJECTIVE: To investigate the effect of 5-fluorouracil (5-FU) ointment on the inner ear of guinea pigs. STUDY DESIGN AND SETTING: In group A (n = 7), 5-FU ointment was applied into the left external auditory canal. In group B (n = 10), 5-FU ointment was applied to the left middle ear through myringotomy. In both groups, the right ear served as a control. One week later the endocochlear DC potential (EP) was measured and morphology of the cochleae was examined using scanning electron microscopy (SEM) and light microscopy. RESULTS: In group A, there was no significant difference between the EP values of the experimental side and the control side. In group B, there was a statistically significant difference between them (P < 0.05). Morphologic findings showed no damage. CONCLUSION: 5-FU ointment application to the external ear seems to be safe but its application to the middle ear may pose some risk of ototoxicity.

Laryngeal Solitary Fibrous Tumor Treated with a Transcervical Approach

Solitary fibrous tumor (SFT) is a relatively rare mesenchymal tumor that usually arises from the pleura. With respect to the head and neck regions, SFT in the larynx is extremely rare. To date, only seven patients with supraglottic laryngeal SFT have been described in the literature. However, no patient with laryngeal SFT present in the subglottic space has yet been described. We herein report the first case of laryngeal SFT localized in the subglottic space. A 68-year-old man was referred with a six-month history of hoarseness and a one-month history of difficulty breathing. He had never smoked and was not on medication. Fiberoptic laryngoscopy revealed a smooth submucosal mass present in the subglottic cavity. The remainder of the larynx, including the vocal cords, appeared normal. The movement of the bilateral vocal cords was preserved well. The routine laboratory values were unremarkable. CT with contrast revealed a 2.5 4 cm well-defined mass with slight enhancement, which was located between the thyroid cartilage and the cricoid cartilage (Fig 1). Because his dyspnea was severe and it was speculated that it would become worse with surgical intervention, a tracheostomy was performed with the patient under local anesthesia, and a specimen was biopsied. The histologic features of the tumor were consistent with the diagnosis of a laryngeal SFT. In addition, the tumor had some atypical histologic features, such as hypercellularity, a high mitotic count, and a high Ki-67 labeling index, which indicated that the tumor had a malignant potential (Fig 2). The mitotic count was six per 10 high power fields. The patient’s tracheostoma was maintained after the biopsy, and a curative resection was thereafter performed with the patient under general anesthesia. The tumor and a small portion of skin adherent to the tumor were separated from the surrounding normal tissue by electrode knife and excised by a transcervical approach without a laryngectomy. It lay at the center of the ligament cricothyroideum. Laryngeal mucosa, bilateral

Wound Infection to the Silk Sutures after Thyroid Surgery

A mild reaction to surgical sutures after thyroid surgery is common, but severe reaction with microabscesses and granulomatous masses is extremely rare. We report a case of wound infection around the silk sutures after thyroid surgery. A 40-year-old woman complained of abscess in the anterior region of the neck. Subtotal thyroidectomy for Basedows disease was performed when she was 36-year-old. There-after she developed fistula, granulation, and subcutaneous tumors around the scar. A CT scan of the neck demonstrated a small collection suspected to be microabscesses along both sides and anterior to the trachea. Culture tests for bacteria were negative and her blood count did not show any leukocytosis or eosinophilia. Under general anesthesia, we performed debridement for wound infection using ultrasonically activated scalpels and nylon suture. Ten months after surgery, she has shown an uneventful course.

R084: Influence of Topical Application of b-FGF upon Inner Ear

graine headaches. Mutation analysis is under way. CONCLUSION: MRS with FP is possibly more common than diagnosed, has better prognosis than progressively worsening edematous form of MRS (different disease?), and is frequently associated with minor symptoms known to accompany MRS. The association with UNC-93B deficiency is to be determined. SIGNIFICANCE: 1. Clarifying the clinical picture of MRS with FP, the form of MRS that is rarely studied and reported in the literature. 2. From upcoming results, possible susceptibility to herpesvirus infection in MRS. SUPPORT: This study was partly supported by a grant from the Helsinki University Central Hospital Reasearch Fund.

P103: Large Silicone Sheet with Soft-Wall Reconstruction Surgery

OBJECTIVES: In the treatment of carcinoma of the external auditory canal (EAC), surgical resection has mainly been applied for patients with external ear carcinoma. However, surgical resection severely compromises the quality of life due to sacrificing of organ function. For organ preservation, superselective intra-arterial (IA) rapid infusion chemotherapy was combined with radiotherapy against carcinomas of the EAC. METHODS: Stages, feeding arteries, and outcomes were reviewed. Tumors were staged according to the Pittsburgh staging system. Chemotherapy was administered intra-arterially in the angiography suite via transfemoral catheterization of the feeding arteries. The patients received up to four weekly infusions of cisplatin (100 mg/body). The patients received external beam radiation simultaneously with IA cisplatin infusion chemotherapy at a dose of 2.0 Gy per fraction once daily five days a week with photon beam energy of 6MV (total dose of 60Gy). RESULTS: Four patients underwent superselective IA infusion chemo-radiotherapy. The median follow-up period was 23 months ranging from 12 to 42 months. Two patients were staged as T2 and other patients were staged T3 and T4. All patients were free from neck metastases. Cisplatin was delivered through the posterior auricular artery in three patients and the superficial temporal artery in one patient. Complete response (CR) was obtained in all four patients. Overall toxic side effects were modest. CONCLUSIONS: Surgical treatment of carcinoma of the EAC has always caused functional disturbances such as hearing loss even at its early stages. Superselective intra-arterial infusion chemotherapy can be an effective organ preservation treatment with high cure rates.