Search

Congenital cholesteatoma in the tympanic cavity can be divided into two types - the closed-type cholesteatoma, which takes the form of a keratotic cyst, and the open-type cholesteatoma, characterized by a flat surface of the epidermis on the middle ear mucosa. Closed-type cholesteatoma is usually identified as a globular white mass through a normal tympanic membrane; whereas the tympanic membrane appears normal in open-type cholesteatomas. Therefore, it is difficult to diagnose open-type cholesteatomas, which are often identified accidentally during exploratory tympanotomy for preoperative diagnoses such as conductive hearing loss. Herein, we report a case of open-type cholesteatoma, in which the diagnosis was suspected from the findings of diffusion-weighted MRI examination using the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique.An 18-year-old male presented to our hospital with the complaint of right hearing loss, which was suspected at a previous ENT clinic to be caused by a congenital ossicular anomaly. Otoscopic examination failed to reveal any abnormalities. Pure-tone audiometry showed moderate conductive hearing loss in the right ear. Computed tomography of the temporal bone revealed a defect of the long process of the incus and superstructure of the stapes, with a surrounding shadow that appeared to be soft tissue. On the basis of these findings, we suspected an open-type cholesteatoma with a defect of the ossicles. Diffusion-weighted MRI examination using the PROPELLER technique showed a high-intensity in the temporal bone, suggestive of a cholesteatoma. We performed exploratory tympanotomy, and found the open-type cholesteatoma in the middle ear. The cholesteatoma was removed without ossiculoplasty, and until now, nine months after the surgery, there has been no sign of recurrence.Our case showed the usefulness of diffusion-weighted MRI using the PROPELLER technique for the diagnosis of the open-type cholesteatoma. The possibility of open-type cholesteatoma should be borne in mind in patients diagnosed preoperatively as having a congenital ossicular anomaly, and diffusion-weighted MRI with the PROPELLER technique is indicated in such patients towards confirming the diagnosis., 浜松医科大学医学部耳鼻咽喉科・頭頸部外科学教室 峯田周幸教授退任記念論文集～症例から学ぶ～, Festschrift for Professor Hiroyuki Mineta In Hornor of His Retirement as Chairman of Hamamatsu University School of Medicine

Objective and method: From the viewpoint of new otolaryngologists, cases of otitis media with effusion (OME) caused by Eustachian tube dysfunction tend to be overlooked, while the mechanism of OME is gradually understood. Children in lower grades with tonsillitis, adenoid hyperplasia, sinusitis, and an immature Eustachian tube have been encountered. Children in upper grades with a habit of sniffing (HS), presenting for treatment by general practitioners, are also encountered. The training involved one case where insertion of a tympanic ventilation tube was requested by the general practitioner and another case with atelectasis. The conditions of the patients were assessed based on interviews, eardrum views, and assessment of the degree of ventilation of the Eustachian tube.Result: The condition of children in lower grades improved with conservative treatment, and the condition of children in upper grades improved with cessation of HS.Discussion: According to the 2015 medical treatment guidelines of OME, tympanic ventilation tubes should be inserted in cases of atelectasis, based on recommendation level A. However, the condition of the patients has been shown to improve with cessation of HS. Young otorhinolaryngologists often perform the insertion of tympanic ventilation tubes. It is important to consider not only the phenomena of hearing loss and exudate retention in the tympanum, but also the mechanism of exudate retention. We should make a careful judgement about whether to insert tympanic ventilation tubes or not, because the complications of tympanic ventilation tube insertion cannot be ignored., 浜松医科大学医学部耳鼻咽喉科・頭頸部外科学教室 峯田周幸教授退任記念論文集～症例から学ぶ～, Festschrift for Professor Hiroyuki Mineta In Hornor of His Retirement as Chairman of Hamamatsu University School of Medicine

Objective To investigate the effects of habitual sniffing on the postoperative course of pars flaccida cholesteatoma. Study design Retrospective case series study. Setting University hospital. Patients Forty-nine patients (53 ears) with pars flaccida cholesteatoma and history of habitual sniffing before the initial operation. Interventions Patients were divided into a "sniffing cessation group" characterized by sniffing cessation and a "continual sniffing group" characterized by continuation of sniffing despite instructions for conscious cessation. Main outcome measures Hearing level, tympanic membrane findings, tympanograms, mastoid cell development before the operation, and pneumatization 1 year postoperatively. Results The sniffing cessation and continual sniffing groups comprised 35 patients (38 ears) and 14 patients (15 ears), respectively. The average postoperative hearing was slightly better in the continual sniffing group. In the sniffing cessation group, retractions were evident in significantly fewer cases. Retractions were observed in all continual sniffing group cases, with a high percentage of severe retractions, wherein the bottom was not visible. Type A tympanogram was predominant in the sniffing cessation group. Mastoid cell development was not significantly different between the two groups. Satisfactory pneumatization was significantly more common in the sniffing cessation group (Fisher's exact test, p Conclusion Conscious cessation of the sniffing habit could reduce the risk of postoperative retraction and improve pneumatization in patients with pars flaccida cholesteatoma. The presence or absence of the sniffing habit after surgery is a defining factor in postoperative prognosis (retraction, recurrence), and may be a determinant for decisions regarding surgical approach.

Cervical nodal metastasis is the most important prognostic factor in patients with head and neck cancers. Unfortunately, nodal dissection at level IIb carries a risk of damage to the spinal accessory nerve. We aimed to determine the prevalence of level IIb metastasis and the relevance of nodal dissection at level IIb in patients with head and neck squamous cell carcinomas. During neck dissection, level IIb lymph nodes obtained from 181 patients with head and neck squamous cell carcinomas were removed, processed, and histopathologically examined. All specimens were divided into two groups according to the side (affected and unaffected sides). The number of dissected lymph nodes and prevalence of level IIb metastasis in each group were then determined and compared according to the preoperative clinical N stage (cN0 and cN+). The study included 158 men and 23 women with a median age of 65 years (range, 17–89 years). The prevalence of pathologically confirmed level IIb metastasis was 0% for clinically node-negative (cN0) necks on the unaffected side and 10.34% for clinically node-positive necks (cN+), with an overall prevalence of 2.4%. There was a significant association between clinically determined and pathologically confirmed node negativity at level IIb. Our findings suggest that level IIb neck dissection in patients with head and neck squamous cell carcinomas may be required only if preoperative examination reveals multilevel or level IIa metastasis or suspicious level IIb metastasis.

There are no universally accepted treatment recommendations for elderly patients with head and neck carcinomas. This study investigated whether radical treatment in elderly patients resulted in better survival compared with palliative treatment. We retrospectively reviewed the medical records of 724 patients aged > 60 years who underwent treatment for primary head and neck carcinomas at Hamamatsu University Hospital. We evaluated the impact of the following: age, sex, the clinical stage, smoking history, alcohol use history, primary tumor site, performance status, and Osaka Head and Neck Comorbidity Index score on overall survival using a Cox proportional hazards model. The 5-year overall survival rate was significantly greater for the 646 patients initially treated with radical (curative) therapy than for the 78 patients treated with palliative therapy (p

An ameloblastoma is a locally aggressive odontogenic tumour that commonly develops from the odontogenic epithelium within the jawbone. Here we present for the first time a case of a rare primary ameloblastoma in the middle ear cavity, along with some consideration of its treatment and a new classification. A 65-year-old woman presented with a left middle ear cavity tumour. Pathological examination led to the diagnosis of an ameloblastoma. We resected the tumour along with an extensive part of the middle ear mucosa, which made it difficult to have an adequate margin. It is recommended that the remaining bone be ground 2–3 mm beyond the visible margin after resecting the gross tumour. Therefore, several cases are treated with conservative surgery, including physicochemical treatment. This factor should be considered when designing treatment strategies as good alternatives in cases where resection with an adequate margin is difficult.

We previously reported that hypothalamic tumor necrosis factor-alpha (TNF-α) mRNA expression via histamine H4 receptors contributes to the development of cisplatin-induced anorexia; however, its precise mechanisms remain unclear. It has been reported that chemotherapeutic agents induce the suppression of orexin neuron activity, and the administration of orexin inhibits chemotherapeutic agent-induced gastric discomfort. Other studies demonstrated that the central administration of TNF-α impairs the orexinergic system, and that orexin excites the histaminergic system. We investigated the involvement of orexinergic and histaminergic systems in the therapeutic effect of an H4 receptor antagonist against cisplatin-induced anorexia. Cisplatin decreased the expression of prepro-orexin mRNA, which encodes precursors of orexin, in the hypothalamus of mice. The period of expression decreased in parallel with the onset of anorexia, and treatment with an H4 receptor antagonist (JNJ7777120, 10 mg/kg) inhibited the decrease in expression. The effect of the H4 receptor antagonist on cisplatin-induced anorexia in mice was antagonized by an orexin OX2 receptor antagonist (JNJ10397049, 5 mg/kg) rather than an orexin OX1 receptor antagonist (SB408124, 30 mg/kg). Although an OX2 receptor agonist (YNT-185, 20 mg/kg) or a histamine H3 receptor inverse agonist (ciproxifan, 1 mg/kg) inhibited the cisplatin-induced anorexia, the inhibitory effect of the OX2 receptor agonist was antagonized by an H3 receptor silent antagonist (VUF5681, 5 mg/kg). The combination of JNJ7777120 (10 mg/kg) and ciproxifan (0.5 mg/kg) completely resolved the cisplatin-induced anorexia. These results suggest that activation of the orexinergic and histaminergic pathway is involved in the therapeutic effect of an H4 receptor antagonist against cisplatin-induced anorexia.

Pica behavior, kaolin ingestion, in rats and mice can be used as an assessment of nausea and vomiting; however, we observed that the incidence of pica behavior in ICR strain mice varied markedly. We investigated the susceptibility of four strains of mice (ICR, BALB/c, C57BL/6, and DBA/2) to the development of pica behavior.Mice received cisplatin (7.5 mg/kg, i.p.) with or without a serotonin 5-HTAll mice except for ICR strain significantly increased kaolin intake after cisplatin administration. Among the tested strains, DBA/2 mice compared to BALB/c and C57BL/6 mice notably showed pica behavior on both days (P 0.0001). The expression of PPT-A mRNA was significantly increased 8 h after cisplatin administration in all strains, but the increase remained on the second day only in DBA/2 mice (P 0.05). Granisetron significantly inhibited pica behavior in DBA/2 mice on the first day (P 0.0001), but not the second day; however, fosaprepitant completely inhibited the pica behavior on both days (P 0.001).These results indicate that cisplatin-induced pica behavior in mice is likely to be influenced by the genotype, and that DBA/2 mice are useful to analyze the emetogenic or anti-emetic potential of drugs in preclinical studies.

Cancer chemotherapy often induces gastrointestinal symptoms such as anorexia, nausea, and vomiting. Antiemetic agents are effective in inhibiting nausea and vomiting, but patients still experience anorexia. We previously reported that chemotherapeutic agent-induced anorexia is associated with an increase of inflammatory cytokines. Other studies also reported that antagonism of the histamine H4 receptor is anti-inflammatory. In this study, we investigated the involvement of the H4 receptor in the development of chemotherapy-induced anorexia in mice. Cisplatin-induced anorexia occurred within 24 h of its administration and continued for 3 days. The early phase (day 1), but not the delayed phase (days 2 and 3), of anorexia was inhibited by the daily injection of a 5-HT3 receptor antagonist (granisetron). However, a corticosteroid (dexamethasone) or selective H4 receptor antagonist (JNJ7777120) abolished the delayed phases of anorexia. Cisplatin significantly increased TNF-α mRNA expression in the hypothalamus and spleen, and the period of expression increase paralleled the onset period of anorexia. In addition, pretreatment with JNJ7777120 completely inhibited the increased expression. These results suggest that TNF-α mRNA expression via H4 receptors may contribute to the development of cisplatin-induced anorexia, and that H4 receptor antagonists are potentially useful treatments.

This study examined Sal-like protein (SALL)1 methylation profiles in head and neck squamous-cell carcinoma (HNSCC) patients at diagnosis and follow-up, and evaluated their prognostic significance and value as a biomarker. SALL1 expression was examined in a panel of cell lines by quantitative reverse transcription PCR (qRT-PCR). Promoter methylation was determined by quantitative methylation-specific polymerase chain reaction (qMSP) and was compared to the clinical characteristics of 205 samples. SALL1 promoter methylation was associated with transcriptional inhibition and was correlated with disease recurrence in 31.7% of cases, with an odds ratio of 1.694 (95% confidence interval: 1.093-2.626; P = 0.018) by multivariate Cox proportional hazard regression analysis. SALL1 promoter hypermethylation showed highly discriminatory receiver operator characteristic curve profiles that clearly distinguished HNSCC from adjacent normal mucosal tissue, and was correlated with reduced disease-free survival in early stage T1 and T2 patients (log-rank test, P < 0.001). SALL1 methylation was significantly correlated with the methylation status of both SALL3 and CDH1. This study suggests that CpG hypermethylation is a likely mechanism of SALL1 gene inactivation, supporting the hypothesis that SALL1 might play a role in HNSCC tumorigenesis and could serve as an important biomarker.