[in Japanese]

View full abstract

We performed an epidemiological survey to examine the choice of treatment and the method of immunotherapy administration in outpatients (261 males, 266 femals) who visited the Allergy Section of the Department of Otorhinolaryngology at Jikei University Hospital between 1996 and 1998. Since many of the patients had already received ineffective treatment for their symptoms, 80.8% of the subjects, including those who were referred from other hospitals, received immunotherapy. Before administering the therapy, we explained the procedure to the patients and informed them that a long time period was required before the effects of the therapy would be appreciated. Informed consent was obtained from each subject. We examined the treatment process in 143 subjects who received immunotherapy at our hospital ; 34.3% of the subjects discontinued their therapy before the maintenance dose was achieved. The subjects who achieved the maintenance dose took the medicine less frequently and exhibited fewer symptoms than the subjects who discontinued the therapy. For the successful treatment of allergic rhinitis, the severity, symptoms, patient's expectations and life style must be taken into consideration when deciding on a treatment strategy. When immunotherapy is administered, good communication with the patient and measures to encourage the continuation of therapy are essential. New methods, of immunotherapy that do not require frequent hospital visits and injections are needed.

View full abstract

Gastroesophageal reflux disease (GERD) causes a variety of laryngopharyngeal symptoms. Proton pump inhibitor (PPI) therapy is said to be effective, so we assessed the efficacy of clinical diagnosis and empirical therapy in patients using PPI. Possible candidates were chosen based on a symptom checklist, (QUEST).
1. QUEST was conducted for 153 patients reporting throat discomfort. Once-daily 30 mg of lansoprazole was administered to 47.
2. The efficacy of medication in the 47 was 61%.
3. Taking into consideration symptoms, efficacy was 63.6% in abnormal throat sensation, 66.7% in cough, 50% in lingual pain, 50% in hoarseness, 100% in bitter taste, and 100% in heartburn/eructation.
4. No statistically significant correlation was seen between the effectiveness of lansoplazole and the length of discomfort.
Our results show GERD may be suspected when patients report throat discomfort. PPI therapy should be considered clinically and conducted empirically.

View full abstract

We encountered so-called “carcinosarcoma, ” i.e., mixed carcinoma and sarcoma in the same tissue. A 73-year-old man attained “complete” recovery (CR) in chemotherapy and radiation therapy for moderately differentiated squamous cell carcinoma of the hypopharynx, classified as T2N0M0. During followup, an irregular grayish white mass of 3 cm was detected. Based on a diagnosis of recurrent hypopharyngeal carcinoma, we conducted pharyngolaryngoesophagectomy, bilateral modified dissection, and reconstruction with a free jejunal graft. The resected specimen, stained with HE, was histopathologically determined to be squamous cell carcinoma with styloid cornification tendency, whereas spindle cells markedly proliferated over the entire mass. On immunohistological staining, sarcomatous spindle cells were positive for EMA and cytokeratin, showing they were derived from the epithelium, resulting in a definite diagnosis of so-called “carcinosarcoma” thought to result from transformation from squamous cell carcinoma to the sarcomatous tumor due to radiation therapy. This patient has remained relapse-free in the 3.5 years since the last operation.

View full abstract

Keratosis obturans, or external auditory canal cholesteatoma, is characterized by the accumulation of keratinizing substance in the external auditory canal. This condition can lead to the deformation of the osseous meatus.
We report a case of keratosis obturans with enlargement of the sinus meatus, in which the lesion had invaded an area close to the internal carotid artery and the jugular bulb. An ink dot test showed a disturbance in the migration of the epithelium of the tympanic membrane and external auditory canal.
The clinical findings of the present case suggest that the accumulation of keratinized substance in the sinus meatus may have caused the cholesteatomatous lesion in the external auditory canal. Periodic removal of accumulated debris is essential to prevent further bony erosion in such cases.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract