著者
原 稔 高崎 賢治 江夏 薫 海江田 哲 隈上 秀高 小室 哲 高橋 晴雄
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.99, no.7, pp.555-559, 2006-07-01 (Released:2011-10-07)
参考文献数
10
被引用文献数
1

We report three cases of isolated oculomotor nerve palsy caused by paranasal disease. All patients complained of double vision but showed no sign of brain aneurysm or diabetes mellitus. These patients had unilateral disturbance of ocular movement and ptosis, but there was no visual impairment on opthalmologic examination. In two cases, computed tomography (CT) demonstrated soft tissue density (STD) in the posterior ethmoid and sphenoid sinuses and also inside the ipsilateral anterior clinoid process (ACP) of the sphenoid bone. In the other case, CT and magnetic resonance imaging showed STD in the ethmoid sinus and pneumatization in the ACP. In all cases, a bony defect was identified at the inferior wall in ACP, adjacent to the superior orbital fissure. We performed endoscopic sphenoidectomy in two cases and conservatively treated the other case with steroid and antibiotics. In all three cases, ocular movement became normal approximately one month later. Since the oculomotor nerve coursed just under the pneumatized ACP in these cases, we speculated that compression and/or inflammation through the ACP might have induced oculomotor nerve palsy.
著者
豊田 厚二 林 清弘 木村 知郎 中村 正三
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.57, no.1, pp.38-50, 1964-01-01 (Released:2011-10-14)
参考文献数
18
被引用文献数
1

Five typical cases of unilateral malingering claiming a disability insurance were described.Unreliable history, unreasonable shift of the audiometric curve, inconsistent results of the TTS test and an absence or an abnormal pattern of shadow hearing gave us the first clue to be alert for the possibility of malingering in all cases (Fig. 1, 2, 3, 4).Moor's test was usually negative, but some malingerers responded with increase in the bone conduction threshold when the external auditory meatus of the worse ear stopped up with a plug (Fig. 5).Stenger's test was positive in all cases. Using the modified Stenger-Weiland test, it was possible to measure air conduction threshold of the worse ear in cases of unilateral aggravated or simulated deafness. In this test, we tempted malingerers to deny hearing, when the sound from bilateral receivers could be heard on the worse ear and even though in the median plane. By doing this, some reasonable approximation to the true threshold was obtained (Fig. 6 A, B, C, D, F). The result was confirmed by experiments in other patients and students, and the condition necessitating noise masking was also discussed (Fig. 7 A, B, C, D).
著者
森 淳子
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.91, no.9, pp.963-970, 1998-09-01 (Released:2011-11-04)
参考文献数
21
被引用文献数
3 2

A total of 889 patients with olfactory disturbance who were examined at the Olfaction Clinic of Osaka City University Hospital from January 1982 to December 1996 were studied retrospectively using clinical records in order to investigate the relationship between the patient characteristics and prognosis. Etiologically the characteristic variables of head trauma and congenital olfactory disturbance were most strongly associated with poor prognosis. Among patients with rhinosinusitis and head trauma, the characteristic variables of female patients, those with a short period of olfactory disorder, and those with high olfactory acuity before treatment showed faster improvements in olfactory disturbance. None of the characteristic variables had any influence on prognosis in the patients with viral infection. The age and presence of abnormal smell sensations similarly did not have any significant influence on prognosis. Improvement was recognized in most patients within 6 months. Hence, patients with olfactory disturbances should be treated for at least 6 months.
著者
中山 久代 今村 俊一 野沢 出 橋本 かおり 村上 嘉彦
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.89, no.11, pp.1407-1413, 1996-11-01 (Released:2011-11-04)
参考文献数
15
被引用文献数
1

The effectiveness of midodrine administration for the treatment of dizziness in patients with orthostatic dysregulation (OD) was investigated. Midodrine (4mg/day) was administered for 8 weeks to 42 patients with dizziness who were confirmed to have orthostatic dysregulation based on a questionnaire. The patients were subdivided into 3 groups on the basis of blood pressure and Schellong test results. Twenty patients had low systolic pressure, less than 100mmHg at rest in the supine position, twelve patients had orthostatic hypotension, and the other ten patients were diagnosed to have orthostatic dysregulation without low systolic pressure or orthostatic hypotension.The effects of the drug were evaluated objectively on the basis of improvement in the Schellong test results, and subjectively on the basis of the patient's perception of symptoms as described in the OD questionnaire results at 4 and 8 weeks after midodrine administration. In general, the symptoms tended to decrease after treatment in most of the patients. In patients with hypotension or orthostatic hypotension, in particular, excellent improvement was achieved. Improvement occurred not only in the patients symptoms, but also in low blood pressure at bed rest and Schellong test results. These observations suggest that administration of midodrine was efficacious in the treatment of dizziness in patients with orthostatic dysregulation as a probable consequence of poor cir culatory function due to autonomic imbalance.

1 0 0 0 OA 顔面銃創例

著者
久我 むつみ 生井 明浩 濱田 敬永 渡辺 健一 大森 英生 池田 稔
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.87, no.10, pp.1379-1382, 1994-10-01 (Released:2011-11-04)
参考文献数
9

We recently treated a patient with a penetrating gun shot wound from the posterior part of the left ear to the left maxillary sinus. The patient was a 35-year-old male who had been injured by a bullet entering behind his left ear. X-ray films and CT scans of the paranasal sinuses at the time of the initial examination showed a bullet in the frontal part of the left maxillary sinus. Intracranial damage was not suspected. Treatment was carried out on the same day. The wound behind the left ear was opened, and a Caldwell-Luc operation was performed. The bullet was removed from inside the left maxillary sinus. The patient had slight difficulty in movement of the articulus mandibularis. No abnormality of the cranial nerves, including the facial nerve, was observed, and the patient's recovery after the operation was good.
著者
乾 洋史 伊藤 妙子 北原 糺
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.113, no.10, pp.667-678, 2020 (Released:2020-10-01)
参考文献数
44

Magnetic resonance (MR)-based volumetric measurement of the endolymphatic space (ELS) was conducted in patients with acute low-tone sensorineural hearing loss (ALHL), sudden deafness (SD), cochlear Meniere’s disease (cMD), and unilateral MD (uMD), and the results were compared with those in control subjects (CS). Seventy-nine patients with ALHL, 99 with SD, 65 with cMD, 77 with uMD, and 47 CS participated in this study. With the exception of the patients with uMD, none of the subjects had vertigo. Images of the inner ear fluid space, positive perilymph and positive endolymph signal were acquired using a 3-T MR imaging scanner. Three-dimensional images were reconstructed semi-automatically by using anatomical and tissue information to fuse the inner ear fluid space images with the ELS images. The cochlear and vestibular ELS/total fluid space (TFS) volume ratios were 10.2%±6.8% and 17.7%±10.2%, respectively. The cochlear ELS/TFS volume ratio in patients with uMD was significantly higher than that in the CS, and patients with ALHL, SD, and cMD (CS=ALHL<SD<cMD<uMD). The vestibular ELS/TFS volume ratio in patients with uMD was significantly higher than that in the CS and other patients groups (CS=ALHL=SD<cMD<uMD). The cochlear and vestibular ELS volume ratio in patients with uMD and other endolymphatic hydrops-related diseases differed from that in the CS. These results suggest that assessment of the prognosis is possible by MR evaluation in patients with endolymphatic hydrops-related inner ear diseases.
著者
川瀬 哲明 洲崎 洋 高坂 知節
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.89, no.6, pp.681-685, 1996-06-01 (Released:2011-11-04)
参考文献数
18

Masking patterns for 1 kHz pure tone at 20, 40 and 60 dB SL were examined in listeners with age-related hearing impairment and in subjects with normal hearing. As has been reported, as the masking level was elevated, the masking effect increased and spread especially towards higher frequencies as well as around the masker frequency. In listeners with impaired hearing, the spread of masking effects towards the higher frequencies was significantly larger as the hearing level deteriorated. The results of the present study are thought to reflect the broader auditory filter in impaired listeners, particularly on the low frequency side.
著者
大越 俊夫
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.99, no.11, pp.891-896, 2006-11-01 (Released:2011-10-07)
参考文献数
15
被引用文献数
1

Abnormal sensations in the throat can be induced by a wide variety of causes, and therefore requires both mental and physical approaches to treatment. In addition, malignant tumors maybe detected in a small number of patients with complaints of abnormal sensations in the throat, and this must never be overlooked. While there have been numerous reports descring various tests, diagnostic methods for determining the causes of abnormal sensations in the throat as well as administration the of therapeutic drugs vary among facilities and few reports have investigated cases of abnormal sensations refractory to initial treatment. Furthermore, although the involvement of psychogenesis in this illness is not small, the extent of its involvement is extremely difficult to assess. While therapeutic determination using various psychological tests and the effects of mild tranquilizers has been attempted, clarification of the extent of psychogenic involvement in this illness remains difficult, as does the treatment of this illness as a psychosomatic illness in the field of otolaryngology.Improvement in abnormal sensations in the throat is determined by changes in the subjective symptoms of the patient. Many reports on the treatment of abnormal sensations in the throat have focused on the effects of administering a specific drug in response to a defined cause of illness, and few have reported the final improvement rates of the patients included in these studies. In other words, it is important to investigate secondary and tertiary treatment methods and the extent to which abnormal sensations in the throat has been improved in patients with abnormal sensations refractory to initial treatment, as well as the appropriate course of action when improvements are not observed.
著者
甲斐 智朗
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.95, no.7, pp.679-684, 2002-07-01 (Released:2011-11-04)
参考文献数
9
被引用文献数
1 1

Two cases of psychogenic hearing loss in adults are presented with the process of their mental states. Case 1 was a 20-year-old male who complained of unilateral hearing loss and tinnitus on his left side after receiving a “karate” kick on his left temple. Considering the perforation of his left tympanic membrane, his left hearing level was much worse (77.5 dBHL). Later examination of ABR revealed the sensorineural system to be intact, and functional hearing loss was suspected. Further questions about his history disclosed that he was extremely unhappy in his job and wanted to leave his present employment. After discussion with psychiatrists, the diagnosis of psychogenic hearing loss was established.Case 2 was a 23-year-old male who complained of right tinnitus after hearing rifle shooting during night time maneuvers in the Self Defense Forces. In spite of the normal appearances of his external and middle ear, his hearing level was 72.5dBHL. Being treated as acoustic trauma, ABR was performed and it resulted in a completely normal response. In this case, the diagnosis of psychogenic hearing loss was also established.Especially in adults, psychogenic hearing loss is regarded as a kind of conversion disorder. In this disease, getting ill brings some “gain” to the patients. Admission to the hospital separates a patient from his unpleasant job and persons (secondary gain). This is almost compatible with the mental state of case 1. When their desires are converted to physical disorders and are appreciated by another person, they don't have to be concerned by their source of annoyance. Thus their mental states are stabilized (primary gain). This is almost compatible with the mental state of case 2.When assessing patients of Psychogenic hearing loss, their mental states should be considered as there may be various processes involved in the disease.
著者
山岸 益夫 中村 英生 鈴木 正治 長谷川 聡 中野 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.83, no.3, pp.383-390, 1990-03-01 (Released:2011-11-04)
参考文献数
12
被引用文献数
1 1

Morphological and immunohistochemical examinations were performed on the olfactory mucosa of eight patients with olfactory disturbances caused by the common cold (viral infection). The results of olfactory testing and of follow-up examinations were analyzed.H. E. staining revealed three patterns of degeneration. In Group 1 (3 patients) the olfactory epithelium had adequate thickness and a basic arrangement of supporting cells, olfactory receptor cells, and basal cells, but slightly fewer than normal receptor cells. In Group 2 (3 patients) olfactory receptor cells were greatly decreased. Group 3 (2 patients) had olfactory epithelium which was thin and atrophic with no receptor cells or olfactory vesicles, and only the supporting and basal cells remained. Group 1 patients had Grade 2, Group 2 patients Grade 3, and Group 3 patients Grade 4 damage according to our classification of degeneration proposed in 1988.Immunohistochemically, neuron-specific enolase (NSE) immunoreactivity was found in a number of receptor cells in Group 1 with Grade 2 damage and in some in Group 2 with Grade 3 damage. In Group 3 with Grade 4 damage, there was no NSE-immunoreactivity in the epithelium. Glia-specific S-100 protein immunoreactivity was found in Bowman's glands and olfactory nerve bundles in the lamina propria of Group 1 and 2 patients with Grade 2 and 3 damage. Cytokeratin immunoreactivity was found in the basal cells on the basement membrane in all three groups.Seven patients were found to be anosmic with T & T olfactometry, but the three patients in Group 1 responded well to Alinamin- intravenous injection test, and two of them recovered.These results indicate that there is a strong relationship among the appearance of the olfactory epithelium, results of the Alinamin- test and the outcome of olfactory disturbance caused by the common cold. When an olfactory mucosall biopsy performed at the first visit of the patient shows enough functional receptor cells and the Alinamin- test is positive, it is possible that the olfactory disturbance may improve.
著者
原田 康夫 夜陣 紘治 平川 勝洋 中田 将風 竹林 脩文 築家 大介 黒川 道徳 村上 譲 菊屋 義則 野田 益弘 二宮 優子 笹 征史
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.79, no.1, pp.161-172, 1986-01-01 (Released:2011-11-04)
参考文献数
15
被引用文献数
1

Patients with pharyngitis and tonsillitis were studied in a randomized double-blind trial to compare the clinical usefulness of MK212G and Isodine gargle.1. Of the 71 patients treated with MK212G or Isodine gargle, four were excluded because they were out of protocol. The results in the remaining 32 patients treated with MK212G and 35 patients treated with Isodine gargle were analyzed statistically.2. MK212G was effective in 93.8% and Isodine gargle in 85.7%, not a statistically significant difference (x2=3.807 N.S.).3. In the MK212G group, one patient complained of oral discomfort and in the Isodine gargle group, two patients had mild nausea and one had vomitting. The difference was not statistically significant (x2=1.165 N. S.).4. MK212G was considered to be clinically useful in 87.51% and Isodine gargle in 82.86%, not a statistically significant difference (x2=0.410 N. S.).5. The above results suggest that MK212G is as useful as Isodine gargle in the treatment of pharyngitis and tonsillitis.
著者
丘村 煕
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.68, no.7, pp.919-935, 1975-07-01 (Released:2011-11-04)
参考文献数
33
被引用文献数
2 2
著者
牛尾 信也
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.64, no.7, pp.699-711, 1971-07-01 (Released:2011-10-14)
参考文献数
20
被引用文献数
2 2
著者
大島 昭夫
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.99, no.8, pp.643-646, 2006-08-01 (Released:2011-10-07)
参考文献数
15
被引用文献数
1 1

Patent eustachian tube patients are becoming increasingly rare.I proposed to classify these patients into a lighter grade I to severe grade III, according to their symptoms and examinations findings and used this to decide on an appropriate therapy.Grade I: Fullness of the ear. No finding in the tympanic membrane during Toynbee's maneuver.Therapy·Administer the Chinese medicine KAMIKIHITO. Pour a mixture of jel-foam, glycerin and 0.9% saline solution into the eustachian tube.Grade II: Grade I plus autophonia and tympanic membrane movement during Toynbee's or Valsalva's maneuver.Therapy·In addition to that proposed for Grade I, submembranous injection of dimethyl polysiloxan or aterocollagen into the nasopharyngeal tubal orifice.Grade III: Most severe case.Therapy·In addition to that proposed for Grade II, insertion of KOBAYASHI's eustachian tube pin into the tympanic orifice of the eustachian tube.
著者
佐藤 宏昭 中村 一 本庄 巖 藤田 明彦 高橋 晴雄 林 正彦
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.81, no.9, pp.1383-1387, 1988-09-01 (Released:2011-11-04)
参考文献数
10
被引用文献数
2 6

The clinical usefulness of Tsumura-Saireito, which was judged by tympanoaudiometric tests, was compared with that of cepharanthin in 64 ears of 42 children with otitis media with effusion. The trial was a randomized controlled study.The efficacy rate for the 32 ears treated with Tsumura-Saireito was 43.8% and that for the 32 ears treated with Cepharanthin was 18.8%; the difference was significant (p<0.05). No side effects were observed in either group.These results indicate that Tsumura-Saireito is more effective in children with otitis media with effusion than Cepharanthin.
著者
佐藤 斎 大滝 一 藤崎 俊之 中野 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.89, no.11, pp.1319-1322, 1996-11-01 (Released:2011-11-04)
参考文献数
8
被引用文献数
1 1

Two cases of psychogenic hearing loss combined with psychogenic aphonia are reported.Case one was a 15-year-old female with psychogenic hearing loss that appeared just before taking a high school entrance examination. After she passed the examination, the complaint of hearing loss was reduced. Three years later she suddenly suffered from psychogenic aphonia prior to taking a college entrance examination. The aphonia also diminished after she passed the examination. Both the hearing loss and aphonia were attributed to the stress caused by the entrance examinations.Case two was a 26-year-old female who suddenly suffered from profound hearing loss and aphonia simultaneously. The conditions were brought on apparently by a psychogenic reaction to a stressful relationship with her mother-in-law.In both cases, the threshold of auditory brain stem evoked response was normal while the threshold of pure tone audiogram indicated profound sensorineural hearing loss. The phonolaryngogram was useful for diagnosis and evaluation of voice disturbance.