The Short- and Long-Term Outcome of Intratympanic Steroid Therapy as a Salvage Treatment for Acute Low-Tone Sensorineural Hearing Loss without Episodes of Vertigo.

OBJECTIVES: To evaluate the hearing outcomes of intratympanic steroid (ITS) treatment for patients with acute low-tone sensorineural hearing loss (ALHL) after failure of initial therapy and to investigate the recurrence and progression to definite Ménière's disease (MD) during a long-term follow-up. METHODS: We retrospectively reviewed the medical records of 90 patients with refractory ALHL who were followed up for at least 1 year between January 2000 and April 2014. Patients who responded poorly to initial medical treatment received intratympanic dexamethasone injections (ITS group) or isosorbide administration for 4 weeks (diuretic group) as salvage treatment options according to their choice of management. The control group did not receive ITS or the diuretic, due to their refusal of both medical treatments. The hearing outcomes were evaluated 1 month, 1 year and 5 years after the completion of the second-line therapy, and the rates of recurrence and progression to MD were measured during a follow-up period of at least 1 year. RESULTS: Twenty-seven patients in the ITS group, 39 patients in the diuretic group and 24 patients in the control group were enrolled. Of these, 12 patients in the ITS group, 15 patients in the diuretic group and 12 patients in the control group were followed up for over 5 years. We found that the recovery rates and the audiometric functional values after 1 month and 1 year in the ITS group were significantly higher than those in the diuretic and control groups. However, there were no significant differences in the recovery rates or the audiometric functional values after 5 years, or in the rates of recurrence and progression to MD between the groups. CONCLUSIONS: Salvage ITS therapy can provide a relatively good short-term hearing outcome for ALHL patients who have persistent hearing loss despite conventional treatment. However, both recurrence and progression to MD after treatment were observed in some patients during the long-term follow-up.

Nasopharyngeal hyalinizing clear cell carcinoma with EWSR1 rearrangements diagnosed by fluorescence in situ hybridization.

Hyalinizing clear cell carcinoma (HCCC) is a rare, low-grade salivary gland neoplasm with a predilection for the palate and tongue. A 63-year-old woman presented a 14×14×17-mm mass at the roof of the nasopharynx. Endoscopic resection was performed via a transnasal approach. Histopathological findings of the salivary gland tumor indicated hyalinization of the stroma and neoplastic cells with clear cytoplasm without mucin. Fluorescence in situ hybridization analysis revealed that the tumor cells were positive for EWSR1 rearrangement. We finally diagnosed this case as HCCC of the nasopharynx. EWSR1 rearrangements are non-existent in other salivary gland tumors with clear cell change; thus, the identification of this rearrangement was very useful in accurately diagnosing HCCC.

A case of immunoglobulin 4-related disease with bilateral mass-forming lesions in the nasolacrimal ducts.

This case study describes a 58-year-old man with watery eyes, bilateral swelling of the ala nasi and submandibular glands, and a swollen right parotid gland. Computed tomography revealed mass-forming lesions in both nasolacrimal ducts, extending bilaterally to the lacrimal sac and inferior meatus in the nose. Pathologic investigation showed marked infiltrates of immunoglobulin 4 (IgG4)-positive plasma cells in the nasolacrimal duct lesion, which led us to diagnose IgG4-related disease. Oral prednisolone improved the symptoms of watery eyes and the bilateral swelling of the nasolacrimal duct and salivary gland enlargement. To the best of our knowledge, this is the first report of IgG4-related disease involving mass-forming lesions in the nasolacrimal ducts.

False-negative diffusion-weighted MRI in acute cerebellar stroke.

OBJECTIVE: To heighten physician awareness of false-negative diffusion-weighted (DW) magnetic-resonance imaging findings in patients with acute cerebellar infarction and the importance of periodically observing nystagmus after symptom onset. METHODS: Between April 2007 and March 2010, we retrospectively reviewed the medical records of eight patients who had all complained of severe isolated vertigo or dizziness, and had visited an emergency department within 2-6h of its onset. Intracranial findings on initial magnetic resonance imaging (MRI) were normal. All patients had consulted our department for peripheral vestibular disorders. We periodically observed spontaneous and positional nystagmus 6-24h after symptom onset. RESULTS: In three of the patients, the direction and/or type of nystagmus changed periodically. In four of the patients, severe vertigo, nausea, and vomiting persisted after the nystagmus had been resolved. A repeat MR examination was performed 24h after symptom onset because of the atypical pattern of nystagmus for benign peripheral vestibular disorders, at which point cerebellar infarction was detected. CONCLUSIONS: Physicians who examine patients with acute severe isolated vertigo or dizziness should consider the possibility of false-negative DW MRI findings in case of hyperacute ischemic stroke. It is important to observe the nystagmus periodically after onset. The MR examination should be repeated more than 24h after symptom onset in patients with an atypical pattern of nystagmus for benign peripheral vestibular disorders.

A comparison of the short-term outcome in patients with acute low-tone sensorineural hearing loss.

PURPOSE OF THE STUDY: We aimed to compare the short-term outcome of patients with acute low-tone sensorineural hearing loss (ALHL) treated with steroid alone, diuretics alone or combination treatment. PROCEDURES: Between April 2000 and March 2009, we retrospectively reviewed the medical records of 156 patients with a diagnosis of ALHL. All patients were followed up until improvement or for 8 weeks from the initial examination. Patients were treated with steroid alone (n = 49), diuretics alone (n = 40), combination treatment (n = 46) or they received neither steroid nor diuretics (n = 21). RESULTS: The steroid-diuretic combination therapy for ALHL showed significantly better results than the steroid or diuretic treatments alone (p < 0.05). There were no clinically significant differences in the outcome between the steroid- and diuretic-alone treatments. CONCLUSION AND MESSAGE: The etiology of ALHL is described as both an endolymphatic hydrops and an autoimmunological mechanism so that, as expected, the steroid-diuretic combination therapy was more effective than the steroid or diuretic treatments alone.

The accuracy of (18)[F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma.

BACKGROUND: The aim of this study was to evaluate the accuracy of [(18)F]-fluoro-2-deoxy-D: -glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of lymph node metastasis in patients with papillary thyroid carcinoma. METHODS: In a prospective study performed between January 2007 and December 2009, 74 patients with a diagnosis of papillary thyroid carcinoma confirmed by fine-needle aspiration biopsy were referred to our institution for surgery. Preoperative assessment of metastasis in the central and lateral cervical lymph nodes was done using [(18)F]-fluoro-2-deoxy-D: -glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography. The results for each level of cervical node assessed using these methods were correlated with the pathology reports after surgery. We determined the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the three methods for all levels of cervical lymph node. RESULTS: There were no significant differences in the diagnostic results obtained by [(18)F]-fluoro-2-deoxy-D: -glucose-positron emission tomography/computed tomography and enhanced computed tomography. However, ultrasonography images gave significantly better results than either [(18)F]-fluoro-2-deoxy-D: -glucose-positron emission tomography/computed tomography or enhanced computed tomography alone in identifying metastases on the basis of the level of cervical lymph node. In addition, the overall diagnostic accuracy tended to be higher for the lateral compartment than for the central compartment. CONCLUSIONS: Preoperative assessment by ultrasonography of metastases in the central and lateral cervical lymph nodes might be the best methodology for determining the extent of surgical resection required to remove metastatic lymph nodes adequately in patients with papillary thyroid carcinoma.

Paranasal sinus mucoceles with visual disturbance.

OBJECTIVE: Paranasal sinus mucoceles may cause visual disturbance in patients because of their close proximity to the orbit. We aimed to investigate visual prognosis to determine whether it is influenced by the interval before surgery and the severity of visual disturbance, and to heighten the physician's awareness of the occurrence of this disease. METHODS: We retrospectively reviewed eight surgically treated patients with paranasal sinus mucoceles accompanied by visual disturbances between March 2005 and January 2009, and examined the visual acuity outcome of the patients. RESULTS: Four patients with a mild visual acuity loss showed improvement after surgical drainage within 1 month after onset. Two patients with visual disturbances persisting for more than 1 year did not show postoperative improvements. Although two patient's preoperative visual acuity loss was worse than the ability to count fingers, they showed a remarkable improvement after surgery. CONCLUSIONS: These results show the importance of diagnosing and treating paranasal sinus mucoceles with visual disturbance as soon as possible. In addition, the improvement of visual acuity can be expected if surgery is performed within 1 month after onset, and the patient's preoperative visual acuity loss is mild. However, if patients with severe visual acuity loss consult otolaryngologists at a later date, surgery may still be considered worthwhile.

Non-organic hearing loss in childhood.

OBJECTIVE: The present study aimed to investigate the etiology, symptoms, diagnosis and prognosis of pediatric patients with non-organic hearing loss (NOHL), and to heighten awareness of this disorder among physicians. METHODS: Between January 2000 and July 2009, we retrospectively reviewed the medical records of 47 pediatric patients (aged 6-18 years of age) diagnosed with NOHL. The diagnosis was made when there were audiometric discrepancies between the subjective and objective hearing thresholds of the patient in the absence of any organic disease. RESULTS: Eighteen patients presented with unilateral hearing loss, and 29 showed bilateral hearing loss. Five patients received steroid treatment before the correct diagnosis was made, and six had secretory otitis media and underwent a tympanostomy tube placement. CONCLUSION: If physicians are unaware of the possibility of NOHL; they may misdiagnose children with idiopathic sudden sensorineural hearing loss and administer high-dose steroid treatments or exploratory tympanotomies. Otoacoustic emissions are abolished when NOHL patients have secretory otitis media. In these cases, after tympanostomy tube placement, they should undergo objective electrophysiologic examinations to reevaluate NOHL.

A case of idiopathic lymph leakage in the neck.

A 48-year-old female patient was seen in our institution complaining of sudden onset of swelling and tenderness in the left side of her neck. Computed tomography and magnetic resonance imaging revealed abundant effusions in this area. Since these narrowed the patient's airway, we performed incisional drainage and intra-operatively we observed a transparent, colorless lymph fluid that oozed from the operative field, which was mainly a fatty layer at the supraclavicular area. Dilated lymphatic ducts were seen along the carotid artery and internal jugular vein, but damaged lymphatic ducts and obvious causative disease structures like tumorous lesions were not seen. Idiopathic lymph leakage was diagnosed due to the serous discharge from the left side of the neck and no apparent causative disease. The patient was successfully treated with incisional drainage and dietary restriction. Lymph leakage in the neck is more common after trauma or surgery. To our knowledge, no similar cases have ever been reported.

Thrombolytic therapy for traumatic unilateral renal artery thrombosis.

We report a case of traumatic unilateral renal artery thrombosis that was successfully treated by thrombolytic therapy. The patient was a 17-year-old woman, who had put her left upper abdomen between a wall and the handle of a ground roller when using it. A computed tomography scan with intravenous contrast showed a lack of contrast in the left kidney. Angiography showed complete occlusion of the left renal artery, and the diagnosis was traumatic left renal artery thrombosis. Following angiography, thrombolytic therapy was performed. Urokinase was administered into the left renal artery, and 360,000 units per 1.5 h was required. Thrombus disappeared and flow of left renal artery was observed. Recovery of left renal function was seen on renoscintigraphy. Surgical maneuvers for traumatic renal artery thrombosis are autotransplantation or thrombectomy generally, but we think that thrombolytic therapy following angiography is a less invasive method and saves warm ischemic time.

[A case of parotid carcinoma with hepatic metastasis that responded remarkably to combination chemotherapy of docetaxel, cisplatin and 5-fluorouracil].

A patient who had parotid gland carcinoma with hepatic metastasis (T4N2bM1) underwent 3 cycles of neoadjuvant chemotherapy with docetaxel, cisplatin and fluorouracil (TPF). After this treatment, the patient showed a PR in the primary site and a CR in the hepatic metastasis. Left total parotidectomy and modified radical neck dissection were then performed followed by postoperative irradiation of 40 Gy. No recurrence in the primary site or the neck was seen, but in the metastatic site a recurrence was observed at 8 weeks after the first chemotherapy. The same chemotherapy is now applied in an outpatient setting. Toxicities with neutropenia, nausea and vomiting of CTC Grade 3 were observed, but these toxicities were mild and manageable. TPF is considered to show clinical activity for advanced parotid gland carcinoma, and we consider further investigation necessary.