鈴木 賢二

We reported a retrospective review of the clinical records for a 64 year old male patient with bilateral middle ear squamous cell carcinoma (MESCC), and for the five other patients with MESCC treated at our institution during the last 20 years. The patient with bilateral MESCC has survived and remained tumor free for more than 1.5 years after extended radical resection of the secondary tumor combined with intra-arterial and systemic chemotherapy, radiotherapy and immunotherapy. Four patients with unilateral MESCC were treated with multidisciplinary treatment (induction chemotherapy, surgery and radiotherapy), and the remaining patient was treated with radiotherapy and mastoidectomy. Five of the six patients are alive with no evidence of disease. The patient treated with radiotherapy and radical mastoidectomy died of local recurrence 3 years after diagnosis. We suggest that MESCC should be considered when refractory granulation, long-standing otorrhea, otalgia and facial paralysis are observed. Multidisciplinary treatment, including intra- arterial chemotherapy and en bloc resection of the temporal tumor is useful for the treatment of MESCC and will improve the prognosis of patients with this disease.

Ear drop medication, which delivers a concentrated drug directly to the lesion, is a useful therapeutic approach in that it provides enhanced efficacy at the affected site while avoiding the side effects accompanying systemic administration of the drug. In the present study we evaluated the effectiveness of three recently developed antibacterial agents with no proven ototoxcity: cefmenoxime (CMX), fosfomycin (FOM), and ofloxacin (OFLX). The bacterial eradication rate, the bacterial persistence rate, and the fungal infection rate were 91.4%, 2.9% and 5.7% for CMX, 71.21%, 20.9% and 7.0% for FOM, and 88.4%, 4.7% and 7.0% for OFLX, respectively. For lomefloxacin (LFLX) (with one week of treatment), the eradication rate and the persistence rate were 80.2% and 19.8%, respectively. It is advisable to limit the duration of treatment with the same otic drug; using the drug for more than 4 weeks at the most should be avoided.

We report the results of otoplasty for microtia in 497 ears of 229 patients treated between January 1971 and March 1995. More than 80% of the cases showed satisfactory outcome. Seventy-six ears underwent minor additional surgery. When cartilage exposure occurred because of skin necrosis we used a free skin graft or a pedicled flap or sutured closely.

In this paper, we studied 3 children with moderate hypertrophy of the palatine tonsils and adenoids and serious congenital diseases. The first patient was a 4-year-old girl with Fallot's tetralogy, the second was a 6-year-old girl with Goldenhar syndrome and ventricular septal defect, aortic stenosis and patent ductus arteriosus, and the third was a 3-year-old boy with cerebral palsy and epilepsy. We examined obstructive apnea during sleep in these patients using all-night polysomnogram or apnomonitor before surgical therapy. After tonsillectomy or adeno-tonsillectomy we confirmed significant improvement of clinical symptoms and obstructive sleep apnea in these patients by all-night polysomnograms or apnomonitor.

We recently reported the development of a chinchilla model of experimental otitis media (OM) that uses a pediatric clinical isolate of adenovirus type 1 (4) and in which an active infection with the wild-type strain was demonstrated. To expand upon these findings, this study was designed to determine whether we could demonstrate adenovirus infection-induced predisposition to bacterial OM in the chinchilla, as has been shown in human epidemiological studies (D. A. Clements, F.W. Henderson, and E. C. Neebe, p. 27-29, in D. J. Lim, C. D. Bluestone, J. O. Klein, D. J. Nelson, and P. L. Ogra, ed., Proceedings of the Fifth International Symposium on Recent Advances in Otitis Media, 1993; F. W. Henderson, A. M. Collier, M. A. Sanyai, et al., N. Engl. J. Med. 306:1377-1383, 1982). In addition, we were interested in determining whether altering the order of pathogen acquisition would further affect the outcome of disease incidence and severity. Toward this end, cohorts of chinchillas were inoculated intranasally with a strain of nontypeable Haemophilus influenzae (NTHi) (86-028NP) which colonizes the chinchilla nasopharynx but does not consistently induce culture-positive OM when inoculated intranasally (L. O. Bakaletz, T. M. Hoepf, D. J. Lim, and B. Tallan, Abstr. 90th Annu. Meet. Am. Sec. Microbiol. 1990, abstr. B-66, p. 37, 1990), adenovirus type 1 and then inoculated 7 days later with NTHi, NTI-Ii and then inoculated 7 days later with adenovirus type 1, or both pathogens concurrently. All cohorts were observed over a 35-day period and assessed for incidence and severity of OM by several methodologies. The data collectively indicated that all animals receiving both pathogens developed OM of greater severity than those receiving only a single agent. Adenovirus inoculation followed 7 days later by NTHi inoculation was the order of pathogen acquisition which induced the most prolonged presence of NTHi in both the nasopharynx and the middle ear, the most severe tympanic membrane inflammation overall, and the most significant damage to and altered function of both middle ear and eustachian tube mucosae,

A rare case of a 51-year-old female with a pleomorphic adenoma, measuring 0.9 X 0.7 X 0.6 (cm3), originating from the right external auditory canal (EAC), was reported. The authors discussed the 7 reported cases of EAC pleomorphic adenoma in Japan, comparing them with pleomorphic adenomas occurring in the nasal cavity and the parotid gland. It is currently too early to conclude that pleomorphic adenoma in the EAC does not tend to recur or shows a marked tendency toward canceration. The best possible treatment for EAC pleomorphic adenoma at present seems to be, as in cases of tumors in other sites, surgical resection together with removal of a sufficient range of surrounding normal tissue, followed by careful long-term postoperative observation of the clinical course. © 1991, Society for Promotion of International Otorhinolaryngology (SPIO). All rights reserved.