著者
桧 学 中西 和仁 岸本 誠司 牛尾 信也 北村 溥之 東辻 英郎 林 正彦 玉城 進 上原 範子 松浦 健次郎 西条 秀明
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.74, no.4special, pp.537-563, 1981 (Released:2011-11-04)
参考文献数
25

におい刺激でおこるめまいの機序を明かにし, その診断法, 治療法を開発する目的で一連の検査が行われ, 次の成果がえられた.(1) におい負荷平衡試験を考案した. この検査では, アリナミン (Diallyl sulfide) 溶液2ml (10mg) のアンプルより1mlをとり出し, それをしみこませた綿花 (1cm3) を被検者の鼻孔前1cmの箇所におき, 口を軽くとぢ, 安静呼吸で60秒間鼻呼吸を命ずる. 刺激中止後10分で愁訴, とくにめまいの変動を問診で確かめ, 各種平衡機能検査で客観化する.(2) (1) で述べた検査を正常成人に実施したがめまいの誘発や平衡失調の出現はなかった. しかし, 頭頸部外傷によるめまい例に施行すると, 次の成績がえられた.1) 受傷後, ある種のにおい物質に過敏となり, それを嗅ぐとめまいをおこした経験のあるものにのみ上述の平衡試験は陽性所見を示した.2) におい負荷平衡試験が陽性所見を示したものはすべて“アドレナリン負荷平衡試験; 桧, 他”が陽性所見を示した. この際, 両者の平衡試験で誘発される平衡失調は, その潜時, その形において相似する傾向を示し, 何れも delayed response を示す傾向が強かった.3) におい刺激で誘発される平衡失調型は病巣の局在と密接に相関した.4) 上肢小脳症状検査で陽性所見を示したものはにおい負荷平衡試験が陽性であることが多く, かつ前者の症状がつよいものほど後者の試験の陽性頻度が高かった.5) 我々が発表した“心因性めまい検出を意図した平衡試験”でA型平衡失調 (心身症型) を示すものは, におい負荷平衡試験で陽性所見をうることが多かった. しかし, A型平衡失調を示すものでも後者の平衡試験が陰性のものもあり, B型平衡失調 (非心身症型) を呈するものでも後者の平衡試験が陽性であることが少なくなかった.6) におい刺激で誘発されるめまい. 平衡失調の治療には cloxazolam (Benzodiazepime 系 minor tranquilizer) は効果がある. しかし, 小脳機能異常を有する例ではその効果を期待しがたい.以上の成績とこれまでにえた動物実験の成績より次の結論をのべた.(1) におい刺激でめまいが誘発される機序のうち, 大脳辺縁系 (とくに扁桃核) 中にふくまれる交感成分の活動性亢進は重要な因子である.(2) におい刺激で誘発されるめまいの機序のうち, 小脳は primary neural element ではない. しかし, その何れかの神経要素に作用し, 機能異常を助長して, におい刺激によるめまい・平衡失調の出現に促進的役割を果す.(3) 心身症によるめまいの機序とにおい刺激で誘発されるめまいの機序は overlap し, 相互に影響を与える可能性はあるが, それぞれの機序が独立した面をもつことを肯定すべきである.(4) 中枢神経系の交感神経成分の活動性抑制を目的とする操作はこの種めまい. 平衡失調の治療法として有用性がある.
著者
大川 正直 一色 信彦
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.93, no.10, pp.867-878, 2000-10-01 (Released:2011-11-04)
参考文献数
24

The glottal flow efficiency (GFE), defined as alternating current component/direct current component of glottal air flow, or AC/DC by Isshiki, and the glottal power efficiency (GPE), defined as acoutic glottal power/aerodynamic glottal power by van den Berg were studied to compare the flow rate, vocal intensity, subglottal pressure, and glottal area.The GFE was found to be a good indicator of the glottal area and vocal fold stiffness, while the GPE was not a good indicator because the noise produced at the glottic also contained acoustic energy.The drawback of the GFE was its inability to correctly reflect the glottal condition, when the air flow provided for phonation was at an unusually low rate or the vocal intensity was at an extremely low level.The critical GFE value indicating a complete glottal closure was estimated at around 50.

1 0 0 0 OA 構音障害

著者
相野田 紀子
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.80, no.11, pp.1643-1645, 1987-11-01 (Released:2011-11-04)
参考文献数
8
著者
菅原 康介 岡村 純 下平 有希 足守 直樹 峯田 周幸
出版者
耳鼻咽喉科臨床学会
雑誌
耳鼻咽喉科臨床 補冊 (ISSN:09121870)
巻号頁・発行日
vol.156, pp.171-176, 2021 (Released:2021-03-11)
参考文献数
17

All penetrating neck wounds are potentially dangerous and require emergency treatment, because there are important vessels, nerves, and organs in the neck. We report the rare case of a 71-year-old man with neck injury caused by a glass fragment that penetrated into the floor of the mouth from the submandibular region. The patient had accidentally fallen through a glass door and sustained a 15-cm long incised wound in his neck. He was initially transferred to a district hospital, where he was diagnosed as having arterial bleeding and a neck injury penetrating into the oral cavity; ENT surgeons at the hospital performed temporary hemostasis and tracheotomy under local anesthesia, and the patient was urgently transported to our hospital by ambulance. On admission, he was conscious, and his general condition was good. CT showed no damage to the major vessels, but revealed free air around the sublingual region. Therefore, emergency surgery was performed to repair the perforation from the neck into the oral cavity under general anesthesia. We found the facial artery and facial vein and ligated them during the operation, and the opening into the oral cavity was closed with absorbable sutures. The postoperative course was good, the patient resumed oral intake on day 4 after the surgery, and he was discharged from the hospital on day 9 after the surgery, with the only postoperative complication of palsy of the marginal mandibular branch of the facial nerve. In this report, we review nine cases of neck injury penetrating into the floor of the mouth and 11 cases of neck injury caused by a glass fragment reported in the literature and discuss their clinical findings.
著者
平田 智也 石永 一 竹内 万彦
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.113, no.12, pp.775-780, 2020

<p>Inflammatory pseudotumor is a benign disease that is histopathologically characterized by the presence of non-specific chronic inflammatory cells. Clinically, these tumors often show neoplastic growth, and it is difficult to differentiate them from neoplastic lesions by imaging findings alone. Inflammatory pseudotumors have been found to occur at various sites, but are rarely found in the head and neck region. Although surgical excision and steroid therapy are effective, no evidence has been established yet. We report a case of an inflammatory pseudotumor that occurred in the cheeks.</p><p>A 51-year-old man with right cheek swelling and pain had visited a local physician a month earlier and antibiotics had been prescribed. Since the symptoms did not improve, CT was performed as an aid to diagnosis, and an abscess or neoplastic lesion was suspected in the cheek. Cytologic examination revealed many neutrophils and histiocytes, but no evidence of malignancy. MRI showed an abscess in the masseter muscle with spread of the inflammation to the surrounding tissues. Antibiotics and steroid therapy were initiated and the swelling diminished in size. When the steroid was withdrawn, the swelling enlarged again. Therefore, inflammatory pseudotumor, non-epithelial tumor, and malignant lymphoma were considered in the differential diagnosis. An excisional biopsy was performed and the diagnosis of inflammatory pseudotumor was established. A subset of the cells was positive for IgG4, but there was no definitive evidence of IgG4-related diseases.</p><p>Treatment of inflammatory pseudotumors includes surgical resection, steroid therapy, radiation therapy, chemotherapy; the efficacy of steroid therapy has been reported for inflammatory pseudotumors in the head and neck region. Although evidence has still not been established, steroid maintenance therapy is effective for preventing recurrence. The patient is currently receiving steroid maintenance therapy on an outpatient basis, and has shown no evidence of recurrence of the inflammatory pseudotumor.</p>
著者
高木 繁 中村 善久 鈴木 元彦 伊藤 博隆 村上 信五 西村 穣 植田 恭弘
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.93, no.10, pp.879-885, 2000-10-01
参考文献数
17
被引用文献数
7 1

The clinical effect of cetirizine hydrochloride on Japanese cedar pollen allergy patients was analyzed by compairing treatment before the start of the pollen season and treatment after the pollen had been scattered.<br>1. Based on the symptom-medication score method, treatment before the pollen season shows a significantly lower value than that of treatment within one or two weeks after the pollen had been scattered.<br>2. Analysis also revealed that this medication relieved nasal symptoms, even in cases, occurring after the season had started.<br>3. Cetirizine hydrochloride was an effective initial treatment for the clinical effects of Japanese cedar pollen allergic reactions.<br>These results suggest that cetirizine hydrochloride is useful for the treatment of Japanese cedar pollinosis.
著者
石丸 正 作本 真 長山 郁生 古川 仭
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.11, pp.1489-1494, 1994-11-01 (Released:2011-11-04)
参考文献数
8
被引用文献数
1

We usually use 6 frequencies, 250, 500, 1000, 2000, 4000 and 8000 Hz, in conventional pure tone audiometry. When these 6 points do not show hearing loss, our clinical diagnosis is no hearing loss. If the hearing loss is not located in the clinical 6 frequencies, we cannot detect it.The authors diagnosed 6000 Hz-dip type acute hearing loss in a 43-year-old male with tinnitus. We measured the hearing levels at 6 frequencies and found no hearing loss. The pitch of his tinnitus was 6000 Hz, so we measured the hearing levels at 4 other frequencies (800, 1500, 3000 and 6000 Hz) and detected a 6000 Hz-dip.Steroid treatment cured both the tinnitus and the 6000 Hz-dip hearing loss.When hearing loss occurs at a frequency other than the conventional pure tone audiometric frequencies, a mistaken diagnosis of no hearing loss is made. If the patient complains of tinnitus, the clinician should investigate the pitch and measure the hearing level near the frequency of the tinnitus. This is a useful method of discovering narrow diptype acute hearing loss.
著者
大森 孝一 藤村 真太郎 水野 佳世子
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.114, no.1, pp.1-10, 2021 (Released:2021-01-01)
参考文献数
48

Digital transformation (DX) was a term proposed by Stolterman et al., who stated that the ongoing development of information technology could be of service to better people’s lives. DX is reshaping interactions between health professionals and patients, decisions about treatment plans, and medical outcomes. Based on key trends from big data, artificial intelligence (AI) and next-generation communication, DX offers the hope for better medical care of prevention, diagnosis, treatment, and welfare for patients. Big data aggregates information about electronic medical records, insurance receipts, patients’ registries, genome/omics, and biological information from wearable devices. AI health programs enable automatic analysis of endoscopic images, CT images, MR images, and voice data to enable diseases to be diagnosed by machine learning of the inputs gathered from thousands of data sets. Next-generation 5G communication is expected to enable smooth telemedicine with little delay, such as for hearing aid fitting and cochlear implant mapping. Telerobotic surgery has also been reported. Emerging digital technologies will change the face of otolaryngological medical care.
著者
下郡 博明
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.114, no.1, pp.65-69, 2021 (Released:2021-01-01)
参考文献数
13

This study was performed to analyze the characteristics of patients with a definitive diagnosis of mumps outside the sentinel surveillance population. Patients aged 15 years or older who visited the otolaryngology department of Yamaguchi Rosai Hospital between October 2015 and April 2017 were included. A definitive diagnosis of mumps was obtained in 8 patients, based on the detection of mumps-specific IgM antibody in the blood. There were 4 male and 4 female patients, ranging in age from 16 to 44 years, with a mean age of 31.4 years. None of the 8 patients had received mumps vaccination. In regard to the swelling of the salivary glands, a single swelling was observed in 4 patients and multiple swellings in the remaining 4 patients. The most commonly affected salivary gland was the left parotid gland (7/8 patients; 87.5%). The complications included hearing loss in 2 of 8 patients, and vertigo and orchitis in one patient each. There were no significant differences in the peripheral blood white blood cell count, serum CRP level, or antibody index between the patients with and without complications. However, the serum amylase level was statistically significantly higher in patients with complications than in those without complications, suggesting the possibility that elevated serum amylase may be marker of the development of complications.
著者
内藤 健晴 堀部 智子 堀部 晴司
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.100, no.4, pp.241-250, 2007-04-01 (Released:2011-10-07)
参考文献数
34
被引用文献数
4

Pharyngeal flap construction surgery is a treatment for velopharyngeal incompetence in cleft palate children. Velopharyngeal incompetence is a major cause of dysphemia. In our department, we assessed velopharyngeal competence in 382 cases from 1992 to 2006 by inspection of the soft palate length or movement, lateral view of X-ray, aerodynamic study, nasometry and naso-pharyngeal fiberscopic examination, and evaluated incompetence in 88 cases. In 22 of the 88, we perfomed pharyngeal flap construction because of failed speech therapy. Usually, palatal re-push back was combined with pharyngeal flap construction and we had a satisfactory postoperative course. We should pay attention to the conceivable complications of the operation, such as mouth breathing, snoring, obstructive sleep apnea, bradycardia, cardiac arrest, underdevelopment and otitis media with effusion. Speech therapy has to be still required although these patients have received surgery for velopharyngeal incompetence.
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.