Nasal septal abscess caused by anaerobic bacteria of oral flora.

Although nasal septal abscess (NSA) was formerly common, it has become rare since the development of antibiotics. NSA, if left untreated, can lead to intracranial complications such as meningitis and eventually result in saddle-nose deformity. NSA often occurs after injury, and indigenous skin bacteria such as Staphylococcus aureus are frequently detected. We treated a patient who had injured the upper alveolus in a fall on the stairs and developed NSA two weeks later. Anaerobic bacteria, including Veillonella parvula and Peptostreptococcus sp., were detected. Symptoms were relieved by needle and incisional drainage. Our patient represents a very rare case of NSA in terms of the cause of onset and the detected bacteria. Early drainage can result in good outcomes.

Two cases of thermal burns of the larynx in older men.

Cases of thermal burns of the larynx in infants and in patients with mental illness have been reported, but those in older people are rare. We report two cases of thermal burns of the larynx in older people caused by ingestion of microwave-heated food (meat and potato stew or a bean-jam filled bun). Both patients were users of full dentures. Conservative therapy was effective in one patient, while tracheotomy was performed in the other patient at the time of the initial examination. Hot food is expelled from the mouth as a reflective response, preventing thermal burns of the larynx. However, in older individuals, sense perception is impaired and reflexes are slowed. Further, the oral mucosa is protected if full dentures are placed. Therefore, heat is likely to not be perceived and reflexes occur only after the food has reached the larynx, thereby causing thermal burns of the larynx. The number of such cases may increase as the number of older patients rises in the current aging society. Therefore, raising awareness of such cases is important.

Structural basis for cholinergic regulation of neural circuits in the mouse olfactory bulb.

Odor information is regulated by olfactory inputs, bulbar interneurons, and centrifugal inputs in the olfactory bulb (OB). Cholinergic neurons projecting from the nucleus of the horizontal limb of the diagonal band of Broca and the magnocellular preoptic nucleus are one of the primary centrifugal inputs to the OB. In this study, we focused on cholinergic regulation of the OB and analyzed neural morphology with a particular emphasis on the projection pathways of cholinergic neurons. Single-cell imaging of a specific neuron within dense fibers is critical to evaluate the structure and function of the neural circuits. We labeled cholinergic neurons by infection with virus vector and then reconstructed them three-dimensionally. We also examined the ultramicrostructure of synapses by electron microscopy tomography. To further clarify the function of cholinergic neurons, we performed confocal laser scanning microscopy to investigate whether other neurotransmitters are present within cholinergic axons in the OB. Our results showed the first visualization of complete cholinergic neurons, including axons projecting to the OB, and also revealed frequent axonal branching within the OB where it innervated multiple glomeruli in different areas. Furthermore, electron tomography demonstrated that cholinergic axons formed asymmetrical synapses with a morphological variety of thicknesses of the postsynaptic density. Although we have not yet detected the presence of other neurotransmitters, the range of synaptic morphology suggests multiple modes of transmission. The present study elucidates the ways that cholinergic neurons could contribute to the elaborate mechanisms involved in olfactory processing in the OB. J. Comp. Neurol. 525:574-591, 2017. © 2016 Wiley Periodicals, Inc.

Iliopsoas Abscess Possibly due to Klebsiella pneumoniae Infection after Chemoradiotherapy for Hypopharyngeal Cancer.

Iliopsoas abscess was once an uncommon condition but now occurs somewhat more frequently due to the increasing number of immunocompromised patients, such as those with diabetes. We encountered a case of iliopsoas abscess following chemoradiotherapy for hypopharyngeal cancer. A 60-year-old man was admitted for a sore throat and left neck swelling. Hypopharyngeal cancer was diagnosed, but the patient refused surgery. After two rounds of chemotherapy, febrile neutropenia developed and chest computed tomography (CT) revealed an iliopsoas abscess. The platelet count was low but recovered after administration of antibiotics and could not be explained by puncture of the abscess. CT-guided drainage eventually improved his symptoms. Even for disorders of the head and neck region, iliopsoas abscess should be suspected in immunocompromised patients who develop a fever. CT and magnetic resonance imaging should be performed at an early stage as it is important to determine whether surgical drainage is indicated.

[OCULAR SYMPTOMS OF CEDAR POLLINOSIS IN OTOLARYNGOLOGY].

BACKGROUND: Cedar pollinosis is a disease with various symptoms. Ocular symptoms as well as nasal symptoms appear frequently. However, there are only a few studies examined the incidence rate of ocular symptoms caused by cedar pollinosis. METHODS: Subjects consisted of 545 patients who have consulted our hospital and the affiliated hospitals without any previous treatment during the peak season for cedar pollen dispersal from 2009 to 2013. The patients were asked about their symptoms and quality of life (QOL) using the Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ). RESULTS: Of all the patients, 86% had ocular symptoms. Moreover, itchy eyes had the higher symptom prevalence than watery eyes. The nasal and ocular symptoms were correlated with each other; those patients with ocular symptoms had more severe nasal symptoms. CONCLUSIONS: This study showed that nasal symptoms in pollinosis patients with ocular symptoms were more likely to be severe than those in patients without ocular symptoms.

Neck swelling from a retropharyngeal abscess caused by penicillin-resistant Streptococcus pneumoniae: a case report.

BACKGROUND: In small children, retropharyngeal abscesses usually occur after upper respiratory tract infections. Unlike in adults, these abscesses are difficult to diagnose in small children, and can rapidly develop into deep neck or mediastinal abscesses. CASE PRESENTATION: A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling. Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall. Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck. The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess. After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma. The lesions improved after intraoral incision and drainage, and administration of antibiotics. CONCLUSION: Lymphangiomas and retropharyngeal abscesses are both known to be more common in children than in adults. However, we found no other reports of concomitant presentation of lymphangioma and retropharyngeal abscess in the literature.

BNCT for advanced or recurrent head and neck cancer.

The therapeutic effect of surgery and/or combination of conventional chemoradiotherapy is limited in the patients with recurrent squamous cell carcinoma (SCC) and locally advanced non-squamous cell carcinoma without malignant melanoma (non-SCC) of the head and neck. Currently, clinical trials of BNCT for head and neck cancers are being conducted in some institutes to verify its the effectiveness. BNCT was performed in 10 patients with recurrent SCC, 7 patients with recurrent non-SCC and 3 patients with newly diagnosed non-SCC in our university between October 2003 and September 2007. Eleven patients showed complete remission and 7 patients showed partial remission of irradiated site. The effective rate [(CR+PR)/total cases] was 90%. No severe acute or chronic normal-tissue reactions were observed in any patients. BNCT is effective and safe in the patients with recurrent SCC and locally advanced non-SCC.

Thickening of the cell wall in macrolide-resistant Staphylococcus aureus.

Macrolides are widely used at low dosage for long-term therapy of chronic sinusitis. Twenty clinical macrolide-resistant Staphylococcus aureus strains were morphologically compared with 10 clinical macrolide-sensitive strains. PCR amplification was performed to determine the presence of four known macrolide resistance genes. Transmission electron microscopy revealed significantly thicker cell walls in clinical macrolide-resistant strains. Even though the ultrastructural characteristics were shared by all macrolide-resistant strains, they were not associated with the presence or absence of the known macrolide-resistance genes. We also demonstrated that macrolide-resistant mutant strains derived in vitro from a macrolide-sensitive parent strain had thickened cell walls and did not harbor the known macrolide-resistance genes. These results, therefore, revealed that macrolide-resistant S. aureus strains have thickened cell walls as a common ultrastructural characteristic and that cell wall thickening is likely mediated by an unknown gene which is unrelated to any known macrolide resistance gene.

Ultrastructural cell wall characteristics of clinical gentamycin-resistant Staphylococcus aureus isolates.

The frequent use of gentamycin (GM) ointment for the treatment of skin infections has led to an increase in the number of GM-resistant clinical isolates of Staphylococcus aureus. We examined the ultrastructural characteristics of 14 clinical strains of S. aureus by transmission electron microscopy. Seven of these isolates were GM-resistant, and seven isolates were GM-sensitive. We found that the cell wall of GM-resistant strains (32.24 ± 5.99 nm) was significantly thicker than that of GM-sensitive strains (19.02 ± 2.72 nm). We genetically characterized these isolates by polymerase chain reaction, targeting the genes for three aminoglycoside-modifying enzymes, aac(6')-aph(2''), aph(3')-III, and ant(4')-I. All GM-resistant strains tested carried the gene encoding aac(6')-aph(2''). However, we were unable to establish a link between a specific gene and cell wall thickening, because one GM-resistant strain was also positive for aph(3')-III. We also demonstrated that a GM-resistant mutant strain, derived in vitro from a GM-sensitive S. aureus parent strain (209P), also exhibited a thickened cell wall. These results strongly suggest that a thickened cell wall is a common ultrastructural characteristic of GM-resistant S. aureus clinical strains.

Antimicrobial effects of Burow's solution on Staphylococcus aureus and Pseudomonas aeruginosa.

Burow's solution has been shown to be effective against chronic suppurative otitis media and otitis externa. We demonstrated that Burow's solution had antibacterial effects against Staphylococcus aureus and Pseudomonas aeruginosa, inducing ultrastructural changes in these bacteria in vitro. S. aureus strain 209P and P. aeruginosa strain IID1130 were treated with 13% Burow's solution. Viable cell counts were determined to measure bactericidal effects. Ultrastructural changes in cells of both strains were examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Viable cell counting revealed that S. aureus cells treated with Burow's solution were killed within 30 min. The viable cell count of P. aeruginosa was reduced by 1 × 10(7) colony-forming units/ml (CFU/ml) after a 60-min treatment. SEM examination of S. aureus revealed blebbing on the surface of bacterial cells, whereas TEM revealed undulating deformation of the bacterial cell wall, diluted cytoplasm, and cell membrane detachment. SEM observations of P. aeruginosa revealed a more apparent undulating deformation of the bacterial cell surface. TEM observations also revealed deformations in the bacterial cell wall and diluted cytoplasm in both bacteria. These findings show that Burow's solution is active against S. aureus and P. aeruginosa, resulting in damage to the cell wall.

Esophageal motor dysfunction plays a key role in GERD with globus sensation--analysis of factors promoting resistance to PPI therapy.

OBJECTIVE: Patients with gastroesophageal reflux disease (GERD) also have various extra-esophageal symptoms. Laryngopharyngeal reflux disease (LPRD) is a subtype of GERD associated with globus sensation, but proton pump inhibitor (PPI) therapy achieves disappointing results. This study investigated esophageal motility in GERD patients with globus sensation who were resistant to PPI therapy. DESIGN: The subjects were 350 patients with globus sensation. All patients underwent both laryngoscopy and upper gastrointestinal endoscopy to exclude organic disease. After 4 weeks of treatment with rabeprazole sodium (20 mg daily), the patients were divided into PPI-responsive and PPI-resistant groups. Then we investigated esophageal motility in the PPI-resistant group by a multichannel intraluminal impedance and manometry study. RESULTS: A total of 119 patients (55.6%) were resistant to PPI therapy, among whom 57 patients (47.9%) had abnormal esophageal motility. They included 36 patients (66.4%) with ineffective esophageal motility, 9 patients (14.4%) with achalasia, 6 patients (9.6%) with diffuse esophageal spasm, 5 patients (8%) with nutcracker esophagus, and 1 patient (1.6%) with hypertensive lower esophageal sphincter. There were significant differences of upper esophageal sphincter pressure and esophageal body peristalsis between the patients with PPI-resistant LPRD and healthy controls matched for age and sex. CONCLUSION: Among patients with PPI-resistant LPRD, 47.9% had abnormal esophageal motility.

Efficacy of combined treatment with S-carboxymethylcysteine (carbocisteine) and clarithromycin in chronic rhinosinusitis patients without nasal polyp or with small nasal polyp.

OBJECTIVE: In Japan, fourteen-membered ring macrolides, antibacterial agents, and S-carboxymethylcysteine (SCMC; carbocisteine), a mucolytic, are commonly used to treat chronic rhinosinusitis (CRS), and they are also used in combination. However, no large-scale randomized study has examined the effects of these pharmacotherapies. The aim of this study is to evaluate the effect of combined administration of clarithromycin (CAM), a fourteen-membered ring macrolide, and SCMC, compared with CAM single therapy. METHODS: Patients with CRS were centrally registered and randomly assigned to treatment with CAM (200mg/day) alone (monotherapy group) or CAM (200mg/day) in combination with SCMC (1500mg/day; combination group) for 12 weeks. We assessed the clinical efficacy of the treatments using measures of subjective symptoms and objective findings, health-related quality of life (HRQOL) determined by the 20-Item Sino-Nasal Outcome Test (SNOT-20) score and computed tomography (CT) score. RESULTS: Four hundred twenty-five subjects were enrolled (combination group, 213; monotherapy group, 212). At week 12 of treatment, the rate of effectiveness was significantly higher in the combination group (64.2%) compared with the monotherapy group (45.6%; P=0.001). In addition, objective findings, including characteristics of nasal discharge (P=0.008) and post-nasal discharge (P=0.002) were significantly improved in the combination group. In both groups, SNOT-20 and CT scores were significantly improved from week 0 (P<0.001), and were not significantly different between groups. CONCLUSION: The results indicated that long-term combination therapy with SCMC at a dose of 1500mg/day and CAM at a dose of 200mg/day is effective for improving subjective symptoms and objective findings in adult patients with CRS.

Association between type 1 diabetes mellitus and deposits in the semicircular canals.

OBJECTIVE: To compare the prevalence of cupular and free-floating deposits in the semicircular canals between temporal bones of type 1 diabetes mellitus patients and normal controls. STUDY DESIGN: Case-control histopathologic human temporal bone study. SETTING: Otopathology laboratory in a tertiary academic medical center. SUBJECTS AND METHODS: Twenty-eight temporal bones from 14 patients with type 1 diabetes mellitus and 56 normal temporal bones from 28 age-matched individuals were histopathologically examined. The cupula and lumina of the semicircular canals were examined for evidence of deposits. RESULTS: The prevalence of cupular and free-floating deposits in the lateral and posterior semicircular canals was significantly higher in type 1 diabetes mellitus patients compared with normal temporal bones (lateral, cupular deposits, odds ratio [OR], 5.47; 95% confidence interval [CI], 1.43 to 21.02; free-floating deposits, OR, 8.25; 95% CI, 2.42 to 27.85; posterior, cupular deposits, OR, 41.73; 95% CI, 5.96 to 275.50; free-floating deposits, OR, 7.44; 95% CI, 1.91 to 28.53). The prevalence of these deposits was associated with the duration of disease rather than with aging. CONCLUSION: The findings suggest that type 1 diabetes mellitus is associated with cupular and free-floating deposits in the semicircular canals. The patients with type 1 diabetes mellitus with a longer duration of disease have an increased probability of suffering from benign paroxysmal positional vertigo.

Round window membrane in Ménière's disease: a human temporal bone study.

OBJECTIVES: To disclose the histopathologic findings of the thickness of the round window membrane and the presence of false round window membrane in Ménière's disease. METHODS: Twelve temporal bones from 6 patients with bilateral Ménière's disease, 44 temporal bones from 23 patients with unilateral Ménière's disease, and 102 age-matched normal temporal bones from 56 individuals were histopathologically examined. The thickness of the round window membrane was calculated from 3 different places. In addition, the presence of false round window membrane was investigated in temporal bones with Ménière's disease and compared to the normal temporal bones. RESULTS: A significant difference in the mean thickness of the round window membrane was observed in temporal bones with Ménière's disease compared with normal temporal bones. There was no significant difference in the thickness of the round window membrane between the diseased side and contralateral side in patients with unilateral Ménière's disease. A false round membrane was observed in 9 (25.7%) of 35 Ménière's disease cases and in 5 (4.9%) of 102 normal temporal bones. CONCLUSION: The thickened nature of the round window membrane and the frequent presence of false round window membrane in patients with Ménière's disease may impede the intratympanic injection treatments. The thickened middle layer of the round window membrane may be related to perilymphatic pressure changes observed in patients with Ménière's disease.

Membranous labyrinth volumes in normal ears and Ménière disease: a three-dimensional reconstruction study.

OBJECTIVES: The purpose of this study was to determine the normal volume ranges of cochlear duct, saccule, and utricle, and to assess endolymphatic hydrops in Ménière disease. STUDY DESIGN: Retrospective temporal bone study. METHODS: Three-dimensional (3-D) images of membranous labyrinth were reconstructed from 31 normal temporal bones, six temporal bones from three patients with bilateral Ménière disease, and 16 temporal bones from eight patients with unilateral Ménière disease. Volumes of each part of membranous labyrinth were measured in each temporal bone group after 3-D reconstruction. RESULTS: The mean volumes and upper normal volume limits (over the 95% confidence interval) of the cochlear duct, saccule, and utricle were 7.67 and 9.77 mm(3), 2.42 and 3.68 mm(3), and 10.65 and 16.45 mm(3), respectively. All three patients with bilateral Ménière disease showed endolymphatic hydrops (excess of volume over normal limits) in both ears. Of eight patients with unilateral Ménière disease, five had no symptom in the contralateral ear, whereas three patients had histories of progression from unilateral to bilateral Ménière disease 13-21 years after the initial onset. All of the diseased and three of eight contralateral ears showed endolymphatic hydrops. In contrast, no hydrops was observed in any part of the membranous labyrinth in asymptomatic ears. CONCLUSIONS: Our findings suggest that cochleosaccular hydrops is a sensitive finding in Ménière disease. In addition, the volume data obtained from this study could be useful as a standard value for the assessment of hydrops in diagnostic imaging of the inner ear in Ménière disease.

Potential cause of positional vertigo in Ménière's disease.

OBJECTIVES: To compare the incidence of deposits in the semicircular canals between the temporal bones with Ménière's disease and normal controls and to investigate the relationship between the incidence of deposits and the symptoms of positional vertigo, often seen in patients with Ménière's disease. STUDY DESIGN: Retrospective histopathologic human temporal bone study. METHODS: Twenty-two temporal bones from 11 patients with bilateral Ménière's disease, 28 from 14 with unilateral and 50 age-matched normal temporal bones from 30 individuals were histopathologically examined. Medical records were reviewed for clinical history of positional vertigo and duration of disease. RESULTS: Significant differences were found in the incidence of cupular and free-floating deposits in the posterior semicircular canals between temporal bones with and without Ménière's disease. The incidence of free-floating deposits in the lateral semicircular canals was significantly higher in cases with unilateral Ménière's disease compared with controls. The incidence of these deposits was associated with the duration of disease rather than with aging. All 5 patients with positional vertigo (3 of 11 patients of bilateral Ménière's disease and 2 of 14 of unilateral) had free-floating deposits in at least 1 semicircular canal. CONCLUSION: Our findings suggest a possible causative relationship between cupular and free-floating deposits in the semicircular canals and the symptom of positional vertigo in patients with Ménière's disease.

Characteristic cell wall ultrastructure of a macrolide-resistant Staphylococcus capitis strain isolated from a patient with chronic sinusitis.

Fourteen-membered-ring macrolides have an antiinflammatory effect, in addition to their antibacterial effect, and are widely used at low dosages for long-term therapy for chronic inflammatory disease such as diffuse pan-bronchiolitis and chronic sinusitis. A macrolide-resistant coagulase-negative staphylococcal strain was obtained from the maxillary sinus of a patient with chronic sinusitis, who failed long-term macrolide therapy. The isolated strain was characterized as Staphylococcus capitis and had an MIC for erythromycin greater than 128 microg/ml. Morphological observation demonstrated that this macrolide-resistant S. capitis strain had a thicker cell wall than macrolide-sensitive S. capitis strains. Moreover, the strain was not carrying any other than the four genes that are known mainly to encode for macrolide resistance in S. aureus. Therefore, the strain had an unknown macrolide-resistance mechanism that might be related to cell wall thickening.

Sudden deafness and right-to-left shunts.

PURPOSE: One of the etiologies for idiopathic sudden deafness is considered to be ischemia of the inner ear. Cryptogenic stroke is caused by a right-to-left shunt (RLS). The present study investigated whether RLS is associated with the occurrence of sudden deafness. METHODS: Contrast saline transcranial Doppler ultrasonography was performed to detect RLS. Subjects comprised 23 consecutive sudden deafness patients and 46 age- and gender-matched controls. Clinical characteristics, including vascular risk factors, were compared between sudden deafness and control groups. RESULTS: RLS was more frequent in the sudden deafness group than in controls (48 vs. 17%, p = 0.011). No significant differences in other clinical characteristics were seen between groups. CONCLUSION: RLS may be a potential cause of sudden deafness.

Superselective angiographic embolization for intractable epistaxis.

CONCLUSIONS: Routine embolization of the ipsilateral facial artery (FA) is effective because of the high success rate. The use of different embolic materials for the internal maxillary artery (IMA) and the FA was considered safe because of the absence of major complications. OBJECTIVE: To evaluate outcomes of routine embolization of the FA as well as the IMA ipsilateral to the bleeding site for intractable epistaxis, and outcomes using different embolic materials for the FA and the IMA. PATIENTS AND METHODS: Twenty-two patients with intractable epistaxis who underwent superselective embolization were retrospectively analyzed with a mean follow-up of 7 months. The FA and the IMA ipsilateral to the bleeding site were embolized. Two embolic materials, gelatin sponge and microcoils, were used for the IMA and the FA, respectively. RESULTS: The short-term success rate within the first 7 days was 77.3% (17/22). The long-term success rate was 95.5% (21/22). There were no major complications in 22 cases. Minor complications occurred in 13 cases (59%). These minor complications usually did not last more than a week and most resolved within a day.