Aquired subglottic stenosis is caused by infection, trauma from prolonged intubation and external airway injury, systemic disorders and other origins. Since the pathologic state of these complications may vary in location, severity, duration, cause, and degree of functional impairmant, subglottic stenosis is difficult to manage. In this paper, we present several cases of subglottic stenosis caused by acute infection, Wegener granulomatosis, tracheostomy, invasive thyroid cancer and unkown cause, and discuss the diagnosis and the treatment. Information obtained from the patient's history, physical examination, endoscopic assessment and radiographic evaluation is useful for diagnosis. Management should be individualized according to the pathologic findings, patient age, degree and consistency of stenosis (hard or soft, and diameter of stenosis) and the general condition of the patient. In cases with mild stenosis caused by infection and some kind of systemic disease, the stenotic lesion is managed conservatively, but in more severe cases the stenotic lesion is managed by several surgical procedures. In the treatment of a stenotic lesion, it is important to expand the stenotic area by the resection of the granuloma and scar or the insertion of a cartilageous or bony graft and to maintain an adequate airway preserving the laryngeal functions. A subglottic stenosis cannot be considered as a single entity and treatment must be selected to suit the specific anatomic location.

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Eye and hearing tests are performed during health examinations for schoolchildren in Japan, but olfaction tests are not performed. If olfaction tests were performed in schoolchildren, diseases of the nose would be easier to identify. The pocket smell test (PST) was performed in 5th-grade elementary schoolchildren (n=68). Healthy schoolchildren were diagnosed as having normal olfaction by the PST, but the mint and paint thinner test odors often produced incorrect answers. Since the PST was made in the United States, all of the test odors may not be familiar to some Japanese children. The PST scores were not significantly different between subjects with or without nasal diseases. While the PST is applicable as an olfaction screening test in schoolchildren, it is not sensitive enough to identify nasal diseases.

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We report on a 20-year-old female with petrous bone cholesteatoma. She came to our hospital complaining of hearing loss and tinnitus in her left ear. Her tympanic membrane showed calcification. A pure tone audiogram showed a normal range of hearing in her right ear and a severe mixed type hearing loss in her left ear. A tympanogram indicated a normal range of mobility in both ears. A caloric test with ice water suggested canal paralysis in her left inner ear, and she showed no facial paralysis. CT and MRI examination revealed soft tissue in a petrous apex lesion which extended to the internal auditory canal and labyrinth. From her history and those examinations, congential petrous bone cholesteatoma was highly suspected. To avoid suffering from facial paralysis, an early operation was recommended. She finally agreed to have an operation six month after first medical examination by which time she already suffered from partial facial paralysis. A middle cranial fossa approach was performed for removal of the cholesteatoma. This approach allowed full exposure of the lateral end of the internal auditory canal. The cholesteatoma existed on the internal auditory canal, cochlea and the superior semicircular canal. The greater petrosal nerve was sacrificed in order to remove the cholesteatoma completely. The choice of approach depends upon the localization of the cholesteatoma.

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The authors encountered a patient with Ménière′s disease with a protracted clinical course. She was treated at an outpatient clinic for about 11 years and was therefore available for continued observation. One of the stresses that she suffered was a change in her work situation. Because the frequency of the episodes of Ménière′s disease increased after she had changed her job, it was suspected that an altered environment or her new employment might have played a role in triggering this disease. Furthermore, the entrance examination for her son, an only child, had a relatively significant impact because a typical example of Ménière′s disease complete with recurrent vertigo and tinnitus and a hearing disorder of increasing intensity developed during the period leading up to this examination.
The reasoning behind the delay in starting a more definitive treatment of Ménière′s disease in the present case may be : the same medication had been given for a long time without actively seeking the cause of the disease ; a less than ideal rapport between the patient and her physician ; and the absence of an appropriate response and treatment in spite of notable changes in the patient′s environment. It was believed that a prolonged clinical course without active treatment is at least partly responsible for the exacerbation of her otological symptoms, difficulty in easing other symptoms, and hindrance in providing psychological support to the patient.

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[in Japanese]

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[in Japanese]

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