Yozo Okabe

Vitamin E and vitamin C in the treatment of idiopathic sudden sensorineural hearing loss.

Conclusion. The results of this study suggest that the administration of vitamin E and vitamin C to patients with idiopathic sudden sensorineural hearing loss (ISSHL) has beneficial effects by reducing the level of reactive oxygen metabolites produced by inner ear ischaemia and reperfusion injury after treatment. Objectives. The purpose of this study was to investigate the efficacy of antioxidant vitamin E and vitamin C in the treatment of ISSHL. Patients and methods. In a retrospective chart review, a total of 87 patients were enrolled who fulfilled the following inclusion criteria: 1) sudden onset of sensorineural hearing loss, 2) cause of hearing loss unknown, 3) hearing loss did not fluctuate, 4) arithmetic mean of hearing levels at 250, 500, 1000, 2000 and 4000 Hz exceeded 40 dB and 5) treatment was started within 14 days from the onset of hearing loss. All the patients were treated with steroids and/or alprostadil. In the study group, patients additionally received vitamin E (tocopherol nicotinate, 600 mg/day) and vitamin C (1200 mg/day) orally. Results. The hearing gain after therapy was 29.4 dB and the improvement rate was 63.3% in the study group, compared with 18.5 dB and 44.0% in the control group. Significant improvement was seen in the hearing gain and recovery rate in the study group.

Importance of pre-operative recognition of the nonrecurrent laryngeal nerve

The nonrecurrent laryngeal nerve is vulnerable during thyroid surgery. Pre-operative recognition of this nerve allows surgeons to avoid injuring the nerve. This anomaly depends upon the aortic arch anomaly and, therefore, in some cases, surgeons are able to predict the presence of this nerve pre-operatively by chest X-ray or barium swallow. Two patients with nonrecurrent laryngeal nerve are reported, one of whom, a 48-year-old man, had an abnormal shadow of the aortic arch, which led to confirmation of a right aberrant subclavian artery. Barium swallow plays a decisive role in the diagnosis of nonrecurrent laryngeal nerve, and this test is mandatory in patients who complain of difficulty in swallowing.

View from beneath: pathology in focus. Renal cell carcinoma metastasis to the tongue.

: Metastases to the tongue from distant primaries are very rare. A case of renal cell carcinoma metastasis to the tongue, occurring in a 58-year-old man, is presented and previously reported cases are reviewed.

Intratemporal Facial Nerve Neurinoma Without Facial Paralysis

A 38-year-old man was referred by his general practitioner to our department on 28 October 1991, with a 2-week history of vertigo. A left aural polyp was identified. The audiogram showed a moderate conductive loss on the left side. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of the expanding lesion in the descending portion of the facial nerve. However, there was no seventh nerve paresis. At operation, the neurinoma (Schwannoma) filled the middle ear cleft and extended from the genu to the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb. Facial nerve paresis is the usual presenting feature of a facial neurinoma. The case is presented for the reason that the absence of facial palsy as a presenting feature is rather rare, especially in the cases with large tumor and extensive bone erosion.

Intravagal parathyroid adenoma

An extremely rare case of intravagal parathyroid adenoma is presented. The tumour caused fusiform swelling of the left vagus nerve was shelled out. Post-operatively the left recurrent nerve palsy was recovered in the two months. Serum calcium level returned to normal on the tenth day after the surgical operation without symptoms of hypocalcaemia.

Development of High Frequency Vestibulo-Ocular Responses to Active Head Shaking

Computer aided active head shaking test has several advantages because it can be used clinical at frequencies higher than 2 Hz. In this study, VOR gain and phase were examined over age. For this experiment, we designed an original measurement system composed of EOG, an angular velocity sensor and a microcomputer. VOR gain was expressed by transfer function. Forty normal subjects ranging from 10 to 75 were examined for high frequency VOR responses to active head shaking. VOR gain at frequencies higher than 2 Hz attained the same value as that seen in children below the age of 10 years. The VOR gain was nearly 1 within 2 Hz, decreasing with frequencies above 4 Hz. The effect of aging was shown at frequencies of more than 4 Hz, and appeared in patients above 50 years of age. No obvious phase lag was observed within 5 Hz.

Chondrosarcoma of the parapharyngeal space

Chondrosarcoma is rarely found arising in the head and neck region. An unusual case arising in the parapharyngeal space in a male is reported and the differential diagnosis, pathology and treatment are discussed.

Malignant Lymphoma of the Parotid Gland

A case of malignant lymphoma of the parotid gland was described. A 15-year-old male developed a mass which was a firm and non-tender. The patient underwent a superficial parotidectomy with preservation of the facial nerve. The tumor was a grey, soft mass, 3 X 4 X 4 cm in size. On microscopic examination, the tumor was intraglandular lymph node with invasion of salivary gland tissue. The tumor cells were seen between acini and ducts. A diagnosis of lymphosarcoma, prolymphocytic, nodular type was made according to the WHOs classification system and the patient was refered for radiation therapy. Further investigations, including radio-isotope scanning of liver, spleen and bone and a biopsy of bone marrow revealed no sign of the disease. The patient was treated with 5380R of cobalt irradiation and in follow-up of a one years duration there was no recurrence. Our case fulfilled the criteria which was represented by Hyman and Wolff and we reviewed the literature of this condition.

Chondrosarcoma of Thyroid Cartilage Assuming a Dumbbell Shape.

A 57-year old man had a left anterior neck tumor, and another small tumor was found in the laryngeal ventricle by indirect laryngoscopy. A CT scan showed a well-circumscribed tumor growing from the thyroid lamina into the paraglottic space. Under general anesthesia the tumor was dissected with fenestration of the thyroid ala without any complications, such as hoarseness or deformity. In Japan 35 cases of cartilagenous tumors arising in the laryngeal cartilage have been reported, including our case. In six of these 35 cases the tumor was in the thyroid cartilage. Both chondrosarcoma and chondroma are often seen in the thyroid cartilage, whereas chondroma is seen more frequently than chondrosarcoma in the cricoid carilage.

Quantitative analysis pursuit eye movement by eye tracking test.

Smooth pursuit eye movements when tracking sine waveform target movement of 30° amplitude and 1/3 Hz frequency (eye tracking test: ETT) were quantitatively assessed in 108 normal subjects and 47 patients with various central lesions. Normal subjects were divided into three age groups. Young volunteers were 20 to 39 years old, middle aged volunteers were 40 to 59 years old and elderly volunteers were over 60 years old. Four parameters (absolute error of eye position, absolute error of eye velocity, phase, summation of saccadic eye movents) were calculated. Smooth pursuit eye movements were linearly impaired with senescence. All patients with cerebellar and cerebellobrainstem lesions showed abnormal values in the parameters. Directional preponderance to the lesion side was seen in half the patients with hemispheric lesion. Patients with CP angle tumors without brain stem compression did not have impaired smooth pursuit. The absolute error of eye velocity increased in the ETT recordings when a saccadic pattern was present, while the absolute error of eye position increased in the ETT with an ataxic pattern.