Abrupt Onset of Sensorineural Hearing Loss and Tinnitus in a Patient with Capillary Telangiectasia of the Pons

Capillary telangiectasia is often found incidentally on magnetic resonance imaging and may be associated with minor neurologic symptoms, but there has been little evidence about whether such lesions are responsible for these symptoms. Here we report a case of capillary telangiectasia of the right mid pons, which was associated with the abrupt onset of tinnitus and sensorineural hearing loss. Examination of the auditory brain stem responses showed abnormalities of waves III and IV on the left and bilateral prolongation of the interwave intervals. Optokinetic nystagmus showed slight left-right asymmetry.

Detection of Helicobacter Pylori in the Middle Ear Fluid of Patients with Otitis Media with Effusion

OBJECTIVES: In patients with otitis media with effusion (OME), colonization of the middle ear effusion (MEE) by Helicobacter pylori (HP) was investigated.

STUDY DESIGN: A prospective nonrandomized study with nonpaired, nonmatched controls. Smear preparations were immunostained with anti-HP antibody and were subjected to Gram staining and Giemsa staining. The rapid urease test (CLO) was done.

RESULTS: Twelve of 15 smears for MEE were positive for HP by immunohistochemistry and 14 by Giemsa that were Gram-negative. In 3 with positive immunohistochemistry, the CLO was positive.

CONCLUSION: The results suggest that HP may exist in the MEE of some patients with OME.

Decreased expression of LMO7 and its clinicopathological significance in human lung adenocarcinoma

LIM-domain only protein 7 (LMO7) has been suggested to act as a tumor suppressor for murine lung adenocarcinoma, while its splice variant p100 LMO7/#16 is associated with invasion and metastasis of rat AH130W1 cells. However, the importance of LMO7 in human lung cancer is unknown. We investigated LMO7 protein expression by immunohistochemistry in tumor tissues obtained from 57 patients with adenocarcinoma of the lung using a rabbit anti-LMO7 antibody. Signals for LMO7 were localized to the apical surface of the bronchial epithelium and to the cell membranes of pneumocytes in non-cancerous pulmonary tissues, but were noted circumferentially around the plasma membrane of cancer cells in all 57 patients with adenocarcinoma. The LMO7-positive group (24 patients, 42%) showed equivocal to strong expression of LMO7 in more than 50% cancer cells, while the remaining 33 patients (58%) showed LMO7 expression in less than 50% of their cancer cells. The latter group had significantly more advanced disease than the LMO7-positive group with regard to T factor (p=0.011), nodal involvement (p=0.026) and p-stage (p=0.010; χ(2) test). Multivariate analysis using a logistic regression model showed that LMO7 expression was independently associated with the T factor (p=0.041). Kaplan-Meier analysis showed that a poor prognosis was associated with low expression of LMO7 (p=0.036; log-rank test). Our findings are consistent with earlier observations and demonstrate that LMO7 is inversely correlated with the development and prognosis of human lung adenocarcinoma.

Melanotic oncocytic metaplasia of the nasopharynx as a benign mimicker of malignant melanoma: a case report

Introduction

Melanotic variant of oncocytic metaplasia of the nasopharynx is an extremely rare condition.

Case report

A 73-year-old Japanese man presented with nasal congestion and chill. Nasoscopic examination revealed multiple black nodules around the bilateral torus tubarius. The nodules were biopsied to determine the histology. The clinical differential diagnosis was malignant melanoma or hemangioma. Microscopically, there were oncocytic plump cells with abundant brown pigmented granules showing glandular pattern. No significant atypia was found. The pigment was positive for Fontana-Masson staining, and negative for Berlin blue staining, showing that it was melanin pigment. Immunohistochemically, S100-positive HMB45-negative dendritic cells were also found.

Conclusion

Such a pigmented variant of benign oncocytic lesion is very rare, and only 15 cases have been reported in the English literature. As a benign mimicker of malignant melanoma, melanocytic oncocytic metaplasia should be always taken into consideration in the clinical setting.

Musculoskeletal diseases as a causal factor of cervical vertigo

OBJECTIVE

To analyze the frequency of musculoskeletal diseases in patients with cervical vertigo, as well as the relations of neck tenderness, psychiatric symptoms, and autonomic abnormalities with pain and age.

METHODS

One hundred and seventy-six patients with cervical vertigo were analyzed. The groups with or without pain and the groups aged > or =66 years or < or =65 years old were compared.

RESULTS

Musculoskeletal diseases were very common (present in 86%). In the group with pain, neck tenderness, CMI III-IV, and orthostatic hypotension were significantly more frequent. In the older group, neck tenderness and orthostatic hypotension were significantly more common than in the younger group. Abnormal ETT and OKP results were also frequently observed.

CONCLUSIONS

Musculoskeletal diseases might have a role in cervical vertigo. In addition, there seem to be some relations among neck tenderness, psychiatric symptoms, autonomic abnormalities, pain, and age. Furthermore, brain stem abnormalities may participate in cervical vertigo.

Unusual Corynebacterium mucifaciens isolated from ear and nasal specimens

OBJECTIVE

Corynebacterium mucifaciens was first proposed as a novel Corynebacterium species in 1997. This report describes our experience with the unexpectedly frequent isolation of C mucifaciens.

STUDY DESIGN

By using agar supplemented with several antibiotics, microbiological studies were performed on specimens collected from the ear and nose.

SETTING

A primary and secondary referral hospital.

RESULTS

The organisms grew slowly. Five strains of C mucifaciens were found in specimens of middle ear effusion (MEE) from patients with otitis media with effusion (OME), and four strains were isolated from the nasal polyps and nasal discharge of patients with chronic sinusitis (CRS).

CONCLUSIONS

C mucifaciens was isolated from nine otorhinological specimens.

SIGNIFICANCE

This is the first report about the isolation of C mucifaciens from MEE, nasal polyps, and nasal discharge. Although its pathogenetic role is unknown, the characteristics of this microorganism might make it a potential cause of OME and/or CRS, so further studies are necessary.

EBM RATING

C-4.

Dermatophytosis of the ear

OBJECTIVES

The prevalence and characteristics of patients with and without dermatophytosis of the ear were investigated.

STUDY DESIGN AND SETTING

Prospective clinical study. In 54 patients who complained of slight itching or accumulation of cerumen, and/or who had erythema and scales in the ears, the presence of dermatophytosis was examined by potassium hydroxide and dimethyl sulfoxide (KOH-DMSO test).

RESULTS

Nineteen patients had dermatophytosis of the ear. Dermatophytosis was more frequent in May and June. Other clinical characteristics did not differ markedly from those without dermatophytosis.

CONCLUSION

About one third of patients had dermatophytosis and their characteristics were similar to those of patients without dermatophytosis except for seasonal variation.

SIGNIFICANCE

Dermatophytosis of the ear may be increased. Its diagnosis is difficult without the KOH-DMSO test.

Middle ear pressure in patients with dizziness

The middle ear pressure was analyzed in 112 patients with dizziness. In 37 patients with Meniere's disease, the middle ear pressure on the low-pressure side was significantly lower, the middle ear pressure difference (between the high and low sides) was significantly larger, and the maximum compliance on the low-compliance side was significantly lower than in normal volunteers. The middle ear pressure difference was significantly larger during periods of dizziness or recurrent dizziness than at the time of remission. In patients with Meniere's disease, a middle ear pressure difference of more than 50 decapascals was significantly more common among those with abnormal blood gas levels than among those with normal blood gas levels. In 27 patients with cervical vertigo and 15 patients with vertebrobasilar insufficiency, the middle ear pressure difference was also significantly larger than in normal volunteers. These results suggest that the middle ear pressure difference might be closely related to dizziness in Meniere's disease and less closely related in cervical vertigo or vertebrobasilar insufficiency. The middle ear pressure difference might also be related to abnormal blood gas levels in patients with dizziness.

Detection of Helicobacter pylori in nasal and maxillary sinus specimens from patients with chronic sinusitis

OBJECTIVES

In patients with chronic sinusitis, the colonization of nasal and maxillary sinus tissues by Helicobacter pylori (HP) was investigated using polymerase chain reaction, urease test (CLO test), culture, and immunohistochemical analysis.

STUDY DESIGN

A prospective clinical study.

METHODS

The subjects were 11 patients aged 20 to 72 years with chronic sinusitis who had undergone sinus surgery under local anesthesia. In 7 of 11 patients, the HP status of the stomach was also studied. Nasal and maxillary sinus tissues were studied using polymerase chain reaction, urease test, culture, and immunohistochemical analysis. Helicobacter pylori infection of nasal and maxillary sinus tissues was defined by at least two positive results of different tests.

RESULTS

Three (16%) of 19 nasal and maxillary sinus specimens from two patients were shown to be HP-positive (positive by polymerase chain reaction and immunohistochemical analysis and weakly positive by the CLO test). In one of these two patients, HP infection of the stomach was confirmed. In the other, a positive findings on immunohistochemical analysis suggested HP infection of the stomach. Immunoreactive structures were seen by immunohistochemical analysis in the nasal, maxillary sinus, and gastric specimens of these two patients but were partially degraded.

CONCLUSION

Helicobacter pylori may exist in the nasal and maxillary sinus tissue specimens of some patients with chronic sinusitis with gastric HP infection.

Helical CT scanning of laryngeal deviation

OBJECTIVE

To evaluate helical computed tomography (CT) scanning in patients with laryngeal deviation.

MATERIALS AND METHODS

Five patients with laryngeal deviation and three control subjects underwent helical CT. The laryngeal deviation was idiopathic in one patient and acquired in four. Three-dimensional (3D) images of the laryngeal cartilages and bones, 3D airway surface models, and sequential coronal and axial images were reconstructed for assessment.

RESULTS

The thyroid cartilage was inclined and twisted to the right in three patients, inclined to the right and twisted to the left in one patient, and inclined to the left and twisted to the right in one patient. The infero-posterior part of the thyroid cartilage, and the cricoid and arytenoid cartilages were shifted to the left in four patients. The vocal cords were at the level of C4 approximately C4/C5 in two patients, C4/C5 in one, C4/C5 approximately C5 in one, and C5 approximately C5/C6 in one. In four patients, inclination of the laryngeal cavity to the right may have induced left false vocal cord protrusion. The levels of the two false vocal cords differed in all patients. When the inclination and twisting were corrected on the computer, 3D images of the laryngeal cartilages of the patients became almost the same as those of the control subjects, except for slight deformity of the thyroid cartilage. The width of the right and left thyroid alae was measured on the computer, and was almost equal in all patients. 3D airway surface models of the left hemilarynx resembled those of the right hemilarynx when the angle of view was changed on the computer.

CONCLUSION

Three-dimensional images of the laryngeal cartilages and bones, 3D airway surface models, and sequential coronal and axial CT scans were obtained using helical CT. This method allows the 3D observation of laryngeal deviation, and viewing of images from various directions on the computer was useful to understand the characteristics of laryngeal deviation.

Immunocytochemical distribution of the c-H-ras protein in nasal polyps: localization to the terminal bars

OBJECTIVE

This study was performed to investigate the role of proto-oncogene products, c-H-ras and c-erbB-2, in the pathophysiology of nasal polyps.

METHODS

An immunocytochemical investigation of the expression of proto-oncogene products of c-H-ras and c-erbB-2 was performed on 16 nasal polyps and 15 nasal mucosa specimens.

RESULTS

The c-H-ras protein was found to be localized to the terminal bars of apical cells of the epithelium in 11 of 16 nasal polyps and in seven of 15 nasal mucosa. Localized staining at the terminal bars for the c-H-ras protein was significantly more frequently observed in glandular-cystic type than in edematous type nasal polyps. Such localized staining was significantly more frequently seen in polyp specimens with invaginated epithelia than in those with no invaginated epithelium. Our findings confirmed that the c-erbB-2 protein was mainly localized to the plasma membrane in all samples.

CONCLUSION

These results suggest that the c-H-ras protein localized to the terminal bars plays an important role in the pathophysiology of glandular-cystic type nasal polyps and that it may be related to invagination of nasal polyp epithelium.

Inflammatory cells in nasal mucosa and nasal polyps

OBJECTIVE

Since some controversy exists concerning the frequency of inflammatory cells in nasal polyps, we have compared the frequency of tissue inflammatory cells (lymphocytes, neutrophils, eosinophils and plasma cells) including 11 kinds of lymphocyte subsets in the same specimens of nasal mucosa and nasal polyps.

METHODS

Histopathological observations and flow cytometric analyses were performed on eight mucosal specimens of the inferior turbinates of patients with nasal polyps and on 13 polyp specimens.

RESULTS

Nasal polyps contained significantly more eosinophils, neutrophils and plasma cells than nasal mucosa, and EG2+ cells (activated eosinophils) were significantly more frequent in nasal polyps than in nasal mucosa. Flow cytometric analysis showed that there were no significant differences in the frequencies of lymphocytes and lymphocyte subsets (CD1+, CD2+, CD3+, CD5+, CD7+, CD4+, CD8+, CD10+, CD19+, CD20+ and HLA-DR+ cells) including CD4/8 ratios between nasal mucosa and polyps, though, both nasal mucosa and polyps contained significantly more lymphocytes than eosinophils, neutrophils or plasma cells. The T cell lineage (CD2+, CD3+, CD5+ and CD7+ cells) was found in high frequency and B cell lineage (CD10+, CD19+ and CD20+ cells) in low frequency in both nasal mucosa and polyps. The frequency of HLA-DR+ cells (most of which were activated T cells) was not significantly different between nasal mucosa and nasal polyps.

CONCLUSION

Histopathological and flow cytometric analyses were performed on the composition of inflammatory cells in nasal mucosa of the inferior turbinates and in polyps from the same patients. The elevated numbers of activated eosinophils, neutrophils and plasma cells in nasal polyps compared with nasal mucosa suggest that inflammatory processes play important roles in the pathophysiology of nasal polyps. The frequencies of lymphocytes and lymphocyte subsets were not significantly different between these two tissues.

A case of multiple symmetrical lipomatosis (Madelung's disease)

Multiple symmetrical lipomatosis (Madelung's disease) is a rare disease with multiple symmetrical unencapsulated fatty accumulation diffusely involving the neck, the shoulders and the upper extremities (Kohan et al. Otolaryngol. Head Neck Surg. 1993;108:156-159). We describe a 48-year-old Japanese man with a history of alcoholism and liver cirrhosis who reported gradually enlarging masses in his cervical region for 4 years. MRI revealed large masses suggesting lipomas in the neck. The patient underwent a two-stage lipectomy. This patient is the 13th case reported in Japan since 1978, though over 200 cases have been reported since 1846 in Europe, most of them from the Mediterranean (Kitano et al. ORL 1994;56:177 180; Kaku et al. Endocrinol. Diabetol. 1997;4:103-106).

Arterial blood gas abnormalities in patients with dizziness

Arterial blood gases were analyzed in 121 patients with dizziness. Sixty-one showed arterial blood gas abnormalities in the dizziness period. An increase in bicarbonate was seen in 57, increases in both bicarbonate and arterial carbon dioxide pressure in 8, and a low arterial oxygen pressure in 22 patients. The frequency of the abnormalities was significantly higher in those with central-peripheral diseases than in those with Meniere's disease. Arterial blood gases were also checked at random in the remission period in 22 patients. The frequency of dizziness recurrence was significantly higher in patients with the abnormalities in the remission period than in patients without them. These results indicate that approximately half of the patients with dizziness tend to have arterial blood gas abnormalities in the dizziness period. It is suggested that arterial blood gas abnormalities cause temporary vestibular dehabituation that increases the frequency of dizziness in central-peripheral diseases and Meniere's disease.

On the frequency of thyroid diseases in outpatients in an ENT clinic

The prevalence of thyroid diseases was studied in the ENT department of Kobe Teishin Hospital. Between January 1990 and June 1994, 6,348 outpatients (3,004 women and 3,344 men) visited the ENT department with problems of ear, nose, and throat. Among them 114 patients (82 women and 32 men) were revealed to have thyroid diseases (1.8%). The prevalence of thyroid diseases increased in patients over the age of 40 (4.6% for 40-80 year aged women, 1.6% for 40-80 year aged men). The male/female ratio was about 1:2.7. There was no subjective symptom in 86.8% of the patients. The prevalence of Hashimoto's thyroiditis was 53.5%, nontoxic diffuse goiter 16.7%, cyst(s) 8.8%, adenoma 7.0%, nontoxic nodular goiter 4.4%, subacute thyroiditis or acute exacerbation of Hashimoto's thyroiditis 4.4%, Graves' disease 1.8%, thyroid carcinoma 1.8%, adenomatous goiter 0.8%, and primary hypothyroidism 0.8%. Visible goiter was observed in only 5 patients and 93% of the patients had palpable but not visible thyroids. Therefore, it is important to palpate the thyroid gland during examination of the neck not only in women but also in men. Hashimoto's thyroiditis is thought to be increasing in frequency and is becoming a more important disease in the ENT clinic.

Effect of experimental acidosis on nystagmus in rabbits

Vertigo related to acidosis in Meniere's disease has been reported. This study was undertaken to ascertain whether acidosis has any effect on vertigo. Since patients with Meniere's disease usually show unilateral vestibular dysfunction, unilateral intratympanic injection of streptomycin sulfate (SM) was used to induce unilateral vestibular dysfunction in rabbits. Intratympanic SM injections induced vestibular destruction and elicited severe spontaneous nystagmus and ataxia. Then symptoms of acute vestibular upset gradually subsided and eventually disappeared completely. Three weeks after SM injections, in compensated rabbits, NH4Cl injection or CO2 inhalation was used to induce acidosis. Intravenous NH4Cl injection or CO2 inhalation induced nystagmus and ataxia again. In normal rabbits, no nystagmus was induced by NH4Cl injection or by CO2 inhalation. These results suggest that acidosis might be a cause of recurrence of vertigo in patients with unilateral vestibular dysfunction.

The influence of daily electrical stimulation of the amygdala on optokinetic nystagmus in rabbits

To clarify the role of the amygdala in optokinetic nystagmus (OKN), the following experiment was carried out. Electrical stimulation, using 0.1-ms, 200-Hz pulse waves of 100 microA over a 30-s period, was performed once daily for 10 days to the amygdala of rabbits (medial or lateral area). Daily electrical stimulation of the medial area of the amygdala caused a significant increase of OKN frequency in rabbits.

Clinical evaluation of a knee-ankle-foot-orthosis for hemiplegic patients

The KAFO described provides hemiplegics with effective and dynamic ambulation, because of its light weight, easy application, reasonably located genucentric knee and ankle joints, together with the flexibility of thigh and lower leg cuffs and arch support. The flexibility of this orthosis permits proper torsion of thigh and lower leg cuff. After application of the KAFO, hemiplegics become able to extend or flex their hip or knee joints in a wide range of motion. As the result of these characteristics, hemiplegics can ambulate smoothly and effectively in the KAFO as described in the results and practical investigations.