Yasuomi Kunimoto

Clinical features and treatment outcomes of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV): A retrospective analysis of 235 patients from a nationwide survey in Japan

Objective: We aimed to analyze clinical features and treatment outcomes of otitis media caused by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), i.e. otitis media with AAV (OMAAV). Methods: This survey was performed between December 2013 and February 2014. The study began with a preliminary survey to 123 otolaryngology institutions in Japan to inquire about their experiences with OMAAV patients during the past 10 years, and was followed by a questionnaire survey to investigate clinical and laboratory findings. OMAAV was defined using the criteria described in the text. Results: Two hundred and thirty-five patients classified as OMAAV were enrolled in this study. They were characterized as follows: (1) disease onset with initial signs/symptoms due to intractable otitis media with effusion or granulation, which did not respond to ordinary treatments such as antibiotics and insertion of tympanic ventilation tubes, followed by progressive hearing loss; (2) predominantly female (73%) and older (median age: 68 years); (3) predominantly myeloperoxidase (MPO)-ANCA-positive (60%), followed by proteinase 3 (PR3)-ANCA-positive (19%) and both ANCAs-negative (16%); (4) frequently observed accompanying facial palsy (36%) and hypertrophic pachymeningitis (28%); and (5) disease often involving lung (35%) and kidney (26%) lesions. Four factors associated with OMAAV were found to be related to an unfavorable clinical course threatening the patients hearing and/or lives, namely facial palsy, hypertrophic pachymeningitis, both ANCAs-negative phenotype, and disease relapse. The occurrence of hypertrophic pachymeningitis was associated with facial palsy (p < 0.05), both ANCAs-negative phenotype (p < 0.001), and headache (p < 0.001). The administration of corticosteroid together with an immunosuppressant was an independent predicting factor for lack of disease relapse (odds ratio [OR] = 1.90, p = 0.03) and an improvement in hearing loss (OR =2.58, p = 0.0002). Conclusion: Since OMAAV has novel clinical features, the disease may be categorized as a subentity for the classification of AAV.

Sequential multipoint motion of the tympanic membrane measured by laser Doppler vibrometry: preliminary results for normal tympanic membrane.

Background Numerous studies have reported sound-induced motion of the tympanic membrane (TM). To demonstrate sequential motion characteristics of the entire TM by noncontact laser Doppler vibrometry (LDV), we have investigated multipoint TM measurement. Materials and Methods A laser Doppler vibrometer was mounted on a surgical microscope. The velocity was measured at 33 points on the TM using noncontact LDV without any reflectors. Measurements were performed with tonal stimuli of 1, 3, and 6 kHz. Amplitudes were calculated from these measurements, and time-dependent changes in TM motion were described using a graphics application. Results TM motions were detected more clearly and stably at 1 and 3 kHz than at other frequencies. This is because the external auditory canal acted as a resonant tube near 3 kHz. TM motion displayed 1 peak at 1 kHz and 2 peaks at 3 kHz. Large amplitudes were detected in the posterosuperior quadrant (PSQ) at 1 kHz and in the PSQ and anteroinferior quadrant (AIQ) at 3 kHz. The entire TM showed synchronized movement centered on the PSQ at 1 kHz, with phase-shifting between PSQ and AIQ movement at 3 kHz. Amplitude was smaller at the umbo than at other parts. In contrast, amplitudes at high frequencies were too small and complicated to detect any obvious peaks. Conclusion Sequential multipoint motion of the tympanic membrane showed that vibration characteristics of the TM differ according to the part and frequency.

Deleted in Esophageal Cancer 1(DEC1) Is Down-Regulated and Contributes to Migration in Head and Neck Squamous Cell Carcinoma Cell Lines

Background: Previous studies have shown that the expression of Deleted in Esophageal Cancer 1 (DEC1) is significantly reduced in esophageal squamous cell carcinoma. Patients with head and neck squamous cell carcinoma (HNSCC) often develop esophageal carcinomas. Materials and Methods: We analyzed the expression of DEC1 and histone modifications in HNSCC cell lines. The motility and invasive ability of the HNSCC cell lines were also studied. Results: Of 18 cell lines, 12 (66.7%) showed down-regulation of DEC1. Chromatin immunoprecipitation assays indicated that H3 K27 trimethylation levels in the DEC1-down-regulated cell lines were greater than that in the DEC1-expressed cell lines. Migration assays showed that the DEC1-down-regulated cell lines tended to be more motile than the DEC1-expressed cell lines. Conclusion:DEC1 is down-regulated and tends to contribute to the migration ability of HNSCC cell lines. In addition, H3 K27 trimethylation potentially plays an important role in the regulation of DEC1 expression.

Usefulness of High-Resolution 3D Multi-Sequences for Peripheral Facial Palsy: Differentiation Between Bellʼs Palsy and Ramsay Hunt Syndrome

OBJECTIVE To investigate the usefulness of magnetic resonance imaging (MRI) including three-dimensional (3D) sequences in the differentiation between Bells palsy (BP) and Ramsay Hunt syndrome (RHS). STUDY DESIGN A prospective study. SETTING Tertiary care center. PATIENTS Twenty patients: 15 patients with BP and five patients with RHS. INTERVENTION Diagnostic. MAIN OUTCOME MEASURE Clinical diagnosis (BP or RHS). RESULTS The presence of hyperintensity on 3D-fluid-attenuated inversion recovery sequence (3D-FLAIR) and enhancement on gadolinium-enhanced (CE)-3D-FLAIR and CE-3D-T1-weighted image (3D-T1WI) along the internal auditory canal (IAC) wall were significantly associated with RHS (p < 0.05). Hyperintensity in the inner ear was observed on pre- and postcontrast 3D-FLAIR, and enhancement of the cranial nerve (CN)-VIII was observed only on CE-3D-FLAIR. The presence of these findings also showed significant relationships with RHS (p < 0.05). Moreover, thickening of the CN-VII in the fundus of the IAC in 3D-constructive interference on steady state sequence (3D-CISS) also showed a significant association with RHS (p < 0.05). In contrast, the presence of hyperintensity of the CN-VII in the fundus of the IAC on 3D-FLAIR did not demonstrate a significant relationship (p = 0.95), and enhancement in this region was observed in all cases on CE-3D-FLAIR and gadolinium-enhanced-three-dimensional-T1-weighted gradient echo sequence (CE-3D-T1WI). CONCLUSIONS 3D MRI sequences are useful for differentiating RHS from BP. In particular, the enhancement in the CN-VIII and/or along the IAC wall are valuable findings, and CE-3D-FLAIR is the most useful sequence to evaluate these findings. Thickening of the CN-VII on 3D-CISS is also an important finding.

Sequential motion of the ossicular chain measured by laser Doppler vibrometry

Abstract Objective: In order to help a surgeon make the best decision, a more objective method of measuring ossicular motion is required. Methods: A laser Doppler vibrometer was mounted on a surgical microscope. To measure ossicular chain vibrations, eight patients with cochlear implants were investigated. To assess the motions of the ossicular chain, velocities at five points were measured with tonal stimuli of 1 and 3 kHz, which yielded reproducible results. The sequential amplitude change at each point was calculated with phase shifting from the tonal stimulus. Motion of the ossicular chain was visualized from the averaged results using the graphics application. Results: The head of the malleus and the body of the incus showed synchronized movement as one unit. In contrast, the stapes (incudostapedial joint and posterior crus) moved synchronously in opposite phase to the malleus and incus. The amplitudes at 1 kHz were almost twice those at 3 kHz. Conclusions: Our results show that the malleus and incus unit and the stapes move with a phase difference.

Staged resection for vestibular schwannoma

Abstract Conclusion: Surgery remains the preferred option for large vestibular schwannoma (VS). The presence of unpredictable intraoperative difficulties may convince the operator to suspend the surgery to avoid risks to patient life. Additional surgeries may be mandatory and are better performed using a transcochlear approach. High rates of complications, poor facial nerve results, and a percentage of incomplete removals should be expected in such unfavorable cases. Objectives: To review the results for nine cases of huge VS treated by staged resection. Method: A retrospective case review was performed for all nine patients who underwent staged resection of VS at the Gruppo Otologico between 1984–2012. The decision to perform staged surgery was always made intra-operatively after encountering unpredicted difficulties. Results: The nine patients represented 0.3% of all patients who underwent VS surgery during the same period. Mean tumor size was 4.7 cm (range = 3.0–6.6 cm). Two cases required three surgeries, resulting in a total of 20 operations. In addition, two cases required pre-operative ventriculoperitoneal shunt and one required temporary tracheotomy. After the final stage of surgery, complete removal had been achieved in six of the nine patients. The facial nerve was never preserved anatomically.