著者

吉田 正 中村 光士郎 小林 泰輔 富所 雄一

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.96, no.9, pp.783-789, 2003-09-01 (Released:2011-10-07)

参考文献数

27

被引用文献数

1 1

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Mycosis in the paranasal sinus is commonly found in the maxillary sinus, but rarely in the sphenoid sinus. In this paper, three cases of sphenoid sinus mycosis are reported and the clinical feature are compared with the 25 other cases reported in Japan since 1968. Our three patients had complained of headache and eye pain, which were thought to be characteristic symptoms in the 25 previous cases. One of the three patients had onset with a background of rheumatoid arthritis and needed steroid medication, but the other two patients had no improvement with medication for sinusitis. By CT scanning and MRI, a localized sphenoid sinus lesion was detected as a characteristic findings for paranasal sinus mycosis, showing irregular mosaic contras on CT scanning and low intensity signal on T1 and T2 MRI imaging. The definite diagnosis was made by means of histological examination for a block age in the affected sinus cavity. Endoscopic sphenoidectomy was performed through the parsnaslis of the anterior wall of sphenoid sinus and was usefull for total removal of the lesion.

著者

小林 泰輔 岡田 昌浩 寺岡 正人 中村 光士郎

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.65, no.6, pp.453-459, 2006 (Released:2009-06-05)

参考文献数

15

被引用文献数

1

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Cogan's syndrome is primarily diagnosed based on subsequent episodes of an inflammatory eye disease and rapidly progressive, usually sequential bilateral loss of audiovestibular function. Since there are still no specific tests for the syndrome, it is difficult to diagnose Cogan's syndrome in the early stage before the emergence of both eye and audiovestiubular symptoms. We present a case of a 34-year-old woman who complained of vertigo and bilateral hearing loss. Magnetic resonance imaging (MRI) of the inner ear was performed before the emergence of keratitis. MRI on the 23rd day after onset of hearing loss revealed a slightly high intensity on TI-weighted images in the right vestibule, which showed profound hearing loss. On the 54th day after onset, high signal intensity was noted in the right cochlea, the vestibule, and lateral semicircular canal on Tl-weighted images, but no enhancement. The high signal intensity disappeared seven months after onset, but there was no defect of inner ear signs on the T2-weighted images. A high signal of the inner ear on T1-weighted images is not a specific sign of MRI in Cogan's syndrome, since it is sometimes encountered in the inner ear of labyrinthitis, bleeding in patients with leukemia, and intralabyrinthine schwanoma. However, MRI could be a possible method for the early diagnosis of Cogan's syndrome because this finding might be recognized before the onset of eye symptoms.

著者

小林 泰輔 岡田 昌浩

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.68, no.3, pp.131-137, 2009 (Released:2009-08-01)

参考文献数

15

被引用文献数

3 1

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We report on two cases of cerebellar infarction in the territory of the medial branch of the posterior inferior cerebellar artery (mPICA) mimicking acute peripheral vertigo. Case 1 was a 54-year-old man with WPW syndrome presenting with sudden vertigo. When he was admitted to our hospital, he had direction fixed horizontal nystagmus towards the left. His symptom disappeared in several days, however, MRI revealed a haemorrhagic infarct in the territory of the right mPICA. Case 2 was a 47-year-old man who was admitted with sudden rotatory vertigo. Direction fixed horizontal nystagmus towards the right was noted and head CT was normal. The nystagmus disappeared on the 5th day of the illness and caloric testing did not show canal paresis. Because of prolonged gate ataxia, a CT scan was performed again. It showed a cerebellar infarction and MRI revealed a cerebellar infarction of the left medial hemisphere and vermis. Infarcts of mPICA sometimes cause acute vertigo presenting horizontal direction fixed nystagmus mimicking peripheral vertigo. In a patient presenting with acute vertigo, head MRI should be performed when he or she has history of risk factor for cerebellar infarction such as diabetes mellitus, ischemic heart disease, and so on. The patients with prolonged ataxia and headache should also undergo MRI.

著者

小林 泰輔 弘瀬 かほり 福永 一郎 兵頭 政光

出版者

日本小児耳鼻咽喉科学会

雑誌

小児耳鼻咽喉科 (ISSN:09195858)

巻号頁・発行日

vol.41, no.3, pp.268-271, 2020

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<p>高知県では2016年度から,全額公費負担による新生児聴覚スクリーニングを開始した。同時にスクリーニングと精密聴力検査の結果の追跡が可能になった。2016年度から2018年度の新生児聴覚スクリーニングの受検者数は13,023人,受検率は92.4%であった。この間の新生児聴覚スクリーニングによる「要精密検査」児は98人,要精査率は0.75%であった。一側難聴は23人(出生数の0.12%),両側難聴は32人(出生数の0.16%)であった。現在は,各市町村と書面で直接連絡をとり,結果の集計とフォローアップを行っている。今後はフォローアップシステムをデジタル化するなどで,医療と行政の連携を強化し,あらたなフォローアップシステムの構築を検討しいく必要がある。</p>

著者

小林 泰輔 暁 清文 柳原 尚明 松本 康 町田 敏之 堀内 譲治

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.86, no.3, pp.321-327, 1993-03-01 (Released:2011-11-04)

参考文献数

15

被引用文献数

1 1

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Case 1: a 59-year-old male with a one-year history of diabetes mellitus complained of right sudden deafness with vertigo. Otoneurological examinations showed sensorineural hearing loss of the right ear and bidirectional horizontal gaze nystagmus. MRI revealed infarction of the right cerebellar hemisphere indicating occlusion of the anterior inferior cerebellar artery (AICA). With conservative treatment his hearing returned to the contralateral ear level. Case 2: a 49-year-old female who complained of right sudden deafness with vertigo and ipsilateral facial palsy. Audiometric studies showed total deafness on the right. Bidirectional horizontal gaze nystagmus, together with V, VII, IX and X cranial nerve palsies were recognized. CT and MRI proved infarction of the right cerebellum and pons. Her hearing improved only partially. Other neurological signs disappeared within eight months. Case 3: a 54-year-old male with a history of hypertension and angina pectoris complained of right sudden deafness with dizziness. Right sensorineural hearing loss and spontaneous nystagmus toward the left were noted. His hearing improved on the next day. Two days later, however, he lost consciousness. CT showed no abnormality, but angiography revealed occlusion of the basilar artery.These three cases showed the importance of differential diagnosis between acute hearing loss due to cerebral infarction and idiopathic sudden deafness. We emphasize the diagnostic importance of risk factors such as hypertension and diabetes mellitus and the sign of vertigo with nystagmus of central origin in cases of cerebral infarction.

著者

小林 泰輔

出版者

一般社団法人 日本耳鼻咽喉科学会

雑誌

日本耳鼻咽喉科学会会報 (ISSN:00306622)

巻号頁・発行日

vol.121, no.6, pp.771-776, 2018-06-20 (Released:2018-07-05)

参考文献数

18

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唾液腺には腫瘍性疾患以外にも, 炎症性疾患や嚢胞性疾患が発症する. その代表例が唾石症とガマ腫である. これらは古典的疾患であるが, 近年, その治療法は医療機器や薬剤の進歩により変化してきた. 唾液腺管内視鏡は1990年代にヨーロッパを中心に開発され, 2009年にはじめて日本でも導入された. 唾液腺管内視鏡による唾石摘出術は低侵襲で唾液腺の機能温存を可能にする. 手術適応は, 主に術前の computed tomography(CT) で唾石の位置, 大きさと形状を評価して決める. 顎下腺唾石症では直径5mm以下のものは内視鏡により摘出できる可能性が高いが, 部位や形状により口内法を併用して摘出する必要がある. 腺内結石は唾液腺摘出術の適応である. 唾液腺管内視鏡の操作には learning curve が大きいため, 容易な症例から手術に取り組み徐々にステップアップしていくのが良い. ガマ腫, 中でも顎下型ガマ腫は治療開始前にリンパ管腫や類皮嚢胞との鑑別を確実に行い, 治療方針を決定することが重要である. 近年行われるようになった, OK-432 によるガマ腫の硬化治療は治療の第1選択である. 再発を繰り返す症例に対しては根治的治療である舌下腺摘出術を行う.

著者

澤田 正一 小林 泰輔

出版者

日本小児耳鼻咽喉科学会

雑誌

小児耳鼻咽喉科 (ISSN:09195858)

巻号頁・発行日

vol.41, no.1, pp.41-46, 2020 (Released:2020-11-13)

参考文献数

16

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小児結膜炎-中耳炎症候群33例と中耳炎を伴わない小児急性結膜炎120例の細菌学的検討を行った。小児結膜炎-中耳炎症候群において,眼脂培養では82%から細菌が検出された。細菌は29株検出され,インフルエンザ菌(HI)25株(89%),肺炎球菌(SP)3株(10%),モラクセラ・カタラーリス(MC)1株(3%)であった。眼脂から培養された29株のうち28株(97%)は同種の細菌が鼻咽腔からも検出された。小児結膜炎-中耳炎症候群では,HIが最も重要な原因菌である。急性結膜炎では,65%から細菌が検出され,HI 64株(69%),SP 16株(17%),MC 5株(5%),その他8株(9%)であった。SPまたはHIが検出されたものについて年代別に検討したところ,月齢が上がってくるとHIの比率が上昇していた。小児結膜炎-中耳炎症候群においてはHIが多いが,低月齢ではSPも想定が必要である。

著者

岡田 昌浩 小林 泰輔 中村 光士郎

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.102, no.3, pp.219-223, 2009 (Released:2010-12-03)

参考文献数

20

被引用文献数

9 10

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Hemorrhage following tonsillectomy is still a major complication despite the development of new hot knives. In this study, a retrospective review of 242 adult patients who underwent tonsillectomy in the Department of Otolaryngology, Ehime Prefectual Central Hospital between January 2000 and March 2007 was conducted. Post-tonsillectomy hemorrhage occurring in 56 patients (23.1%); four of these patients experienced hemorrhage during the first 24 hours postoperatively, and the remaining 52 had delayed bleeding. Nine of 56 patients (3.7%) required a procedure to control their bleeding under general anesthesia. The hemorrhage rate in males was significantly higher than in females. There was no statistically significant difference in hemorrhage rates based on age, body mass index (BMI), duration of surgery and smoking. Patients who received antibiotics postoperatively experienced less secondary hemorrhage than those without antibiotics. In 99 patients who were administered antibiotics, patients who used cephalosporins experienced less secondary hemorrhage than those who received penicillins. These results indicate that antibiotics after tonsillectomy are effective to reduce post-tonsillectomy hemorrhage rates.