Frontal sinusitis associated with orbital decompression for Graves' orbitopathy.

Orbital decompression (OD) for Graves' orbitopathy usually includes removal of orbital medial wall. While OD occasionally cause or worsen chronic sinusitis because of the obstructed sinus drainage by prolapsed orbital fat, to date few reports have been published on the management or prevention of sinusitis associated with OD. Here, we present two patients (three sides) with newly developed and one patient (one side) with worsening obstructive frontal sinusitis following OD. These three patients had OD including the removal of the superior attachment of uncinated process to lamina papyracea. Endoscopic modified Lothrop procedure (EMLP) was useful to relieve symptoms and keep an enough access to frontal sinuses for all cases. We also performed EMLP for another two patients (four sides) with pre-existing sinusitis before OD. Worsening of sinusitis could be avoided by EMLP before OD. EMLP was useful approach for both treatment and prevention of sinusitis related to OD. The superior attachment site of uncinated process and the pattern of frontal sinus drainage might predict the occurrence of obstructive frontal sinusitis following OD.

Three-year prospective study on olfaction of patients with Parkinson's disease.

OBJECTIVE: We conducted a 3-year prospective study on olfaction of patients with Parkinson's disease (PD) in order to examine the severity and frequency of smell disorder in PD using odor identification test, Open Essence (OE) and to verify the validity of olfactory tests as a predictor of cognitive symptom onset of PD. PATIENTS AND METHODS: We conducted a prospective study by performing an annual examination over a 3-year period. For 56 cases diagnosed with PD by the Department of Neurology at our hospital, OE and Jet Stream Olfactometry (JSO) were performed to assess the olfactory function, and Mini-Mental-State Examination (MMSE) was conducted to measure cognitive impairment. RESULTS: At the beginning, 56 cases were examined, of which 42 remained to be followed up for 3 years. Based on the results of baseline, we found a correlation between OE and the average cognitive thresholds of JSO, but did not find any correlation between OE and MMSE. OE (median 4.0→4.0) and the average cognitive thresholds of JSO (median 2.2→1.6)　decreased after 3 years, and MMSE (median 29→29) also declined, but not significantly. At the 3rd year, 6 cases with MMSE score of 23 or less were identified as suspected dementia and 36 cases with more than 24 points were defined as an invariant group. In order to distinguish these two groups, OE scores of baselines were evaluated with a combination of 12 odors. Sensitivity 1.0 and specificity 0.722 were obtained and the sensitivity+specificity value (1.722) was the highest when the number of correct answers was 4 or less using an odor combination of lumber, menthol, Japanese orange, gas for household use, Hinoki cypress and condensed milk. CONCLUSION: When the number of correct answers of 6 odors (lumber, menthol, Japanese orange, gas for household use, Hinoki cypress and condensed milk) is 4 or less in patients with PD, there is a possibility that MMSE declines in 3 years.

A laryngeal closure technique for the treatment of patients with head and neck cancer.

BACKGROUND: In 2008, Kano developed a new laryngeal closure technique (Kano's method) for the treatment of severe aspiration. The aim of this study was to evaluate the safety and efficacy of this technique in patients with head and neck cancer. METHODS: Since June 2014 until March 2018, six patients underwent Kano's method for management of severe aspiration after the treatment of head and neck cancers. The anterior parts of the thyroid and the cricoid cartilages were excised widely. The glottis was closed by suturing bilateral vocal folds and reinforced by the sternohyoid muscle. A tracheostoma was created with skin flaps, subglottic mucosal flaps, and stumps of cricoid and trachea cartilages. RESULTS: No severe complications were observed after the surgery. Oral intake improved without developing aspiration. CONCLUSIONS: Kano's method can provide satisfactory functional results with minimal invasion for treating severe aspiration after advanced surgery, chemotherapy, and/or chemoradiotherapy, in patients with head and neck cancer. LEVEL OF EVIDENCE: 4.

Cardiac metastasis in a living patient with oral cancer.

Cardiac metastasis from head and neck cancers are very rare. Metastases to heart are mostly diagnosed at autopsy, and seldom found while patients are alive. Patients with cardiac metastasis do not present with specific symptoms in the early stages, and diagnosis is often delayed until the disease has advanced significantly. Here, we report a 66-year-old lady who was diagnosed with cardiac metastasis 10 months after surgical resection of oral cancer. She died one month following the discovery of cardiac metastasis. Cardiac metastasis should be considered when unexplained and progressive decline of general health is observed, even in the absence of abnormalities on the electrocardiogram. Early diagnosis may be made by analyzing the chronological changes in the cardiac accumulation of fluorodeoxyglucose during positron emission tomography-computed tomography scan.

Characteristics of Smell Identification Test in Patients With Parkinson Disease.

OBJECTIVES: Parkinson disease (PD) is frequently associated with olfactory disorder at early stage, which is caused by deposition of Lewy bodies emerging from the olfactory bulb to higher olfactory centers. Early detection of olfactory disorder in the patients with PD may lead to the early diagnosis and treatment for this refractory disease. METHODS: Visual analog scale (VAS), Jet Stream Olfactometry, and Japanese smell identification test, Open Essence (OE), were carried out on 39 patients with PD. Thirty-one patients with postviral olfactory disorder (PVOD), which was caused by the olfactory mucosal dysfunction, were also enrolled in this study as control. RESULTS: There were no significant differences in detection thresholds (2.2 vs. 1.4, P=0.13), recognition thresholds (3.9 vs. 3.5, P=0.39) and OE (4.8 vs. 4.2, P=0.47) between PVOD and PD, while VAS scores of PVOD and PD were significantly different (2.0 and 6.2, P<0.01). In OE, significant differences were observed in the accuracy rates of menthol (68% vs. 44%, P=0.04) and Indian ink (42% vs. 15%, P=0.01) between PVOD and PD. Of particular interest, patients with PVOD tended to select "no detectable," while patients with PD tended to select wrong alternative other than "no smell detected." CONCLUSION: Discrepancy between VAS and OE, and high selected rates of wrong alternative other than "undetectable" in OE might be significant signs of olfactory dysfunction associated with PD.

Parathyroid adenoma causing spontaneous cervical hematoma: two case reports.

BACKGROUND: Although spontaneous rupture of a cervical parathyroid adenoma with extracapsular hemorrhage is rare, it may cause cervical and mediastinal hematoma, leading to potentially fatal consequences. CASE PRESENTATION: The first case was a 76-year-old Asian female who presented with pharyngeal discomfort and anterior chest ecchymosis. Endoscopic investigation showed submucosal hemorrhage in the pharynx and larynx. The second case was a 62-year-old Asian male who presented with anterior chest ecchymosis and suspected of a ruptured blood vessel. Both cases were diagnosed parathyroid adenoma with extracapsular bleeding by hypercalcemia, high levels of intact parathyroid hormone and presence of a nodule behind the thyroid. Both cases were treated with excision of tumor 7 months after initial presentation. After surgery, serum calcium and parathyroid hormone levels had decreased to normal level in both cases. CONCLUSION: Extracapsular bleeding of a parathyroid adenoma should be considered in the differential diagnosis of non-traumatic neck hematoma.

[A case report of Parkinson's disease presenting with olfactory disturbance as a primary symptom in the early stage].

We report herein on a 71 year-old male who presented with olfactory disturbance at the early stage of Parkinson's disease (PD). Due to a persistent olfactory disturbance for 5 years, the patient visited our clinic and showed disorientation between the olfactory detection threshold and recognition in T&T olfactometry and scored 3 out of 12 points in OE. During the follow-up period, the typical symptoms of PD, including mask-like face and motor disturbance emerged, which led to the diagnosis of PD by the neurologist. Since it is generally accepted that olfactory disturbance precedes the appearance of motor disturbance in the early stage of PD, otolaryngologists should be aware of the necessity of olfactory tests for the patients with reported persistent olfactory disturbance, especially in elderly patients. In those cases where the patients present positive findings in olfactory tests without any particular cause, referral to neurologists is recommended.

Evaluation of card-type odor identification test for Japanese patients with olfactory disturbance.

OBJECTIVES: A card-type odor identification test, Open Essence (OE), was recently developed in order to examine olfactory function in the Japanese population. The purpose of this study was to validate the efficacy of this new test by comparison with established olfactory examinations. METHODS: We administered Jet Stream Olfactometry (JSO), an intravenous olfaction test (Alinamin test), a visual analog scale of symptoms of olfactory dysfunction, and the OE test to 50 patients with complaints of olfactory disturbance and 50 healthy volunteers. After comparison of the OE test results with those of existing olfactory examinations and the symptom scores, we tried to estimate a cutoff value compatible with the JSO threshold. RESULTS: The scores on the OE test showed significant correlations with the average detection thresholds of JSO (r = -0.738; p < 0.0001), the average recognition thresholds of JSO (r = -0.708; p < 0.0001), the symptom scores (r = 0.827; p < 0.0001), and the duration scores of the intravenous olfactory test (r = 0.673; p < 0.0001). The area under the receiver operating characteristics curve between the OE test results and the average recognition thresholds of JSO was highest when the OE test's cutoff value was set at 8. CONCLUSIONS: The OE test proved to be a useful tool for screening olfactory disturbance in the Japanese population. Scores of 8 or higher on the OE test should be judged as normal for screening.

Near-infrared spectroscopy of orbitofrontal cortex during odorant stimulation.

BACKGROUND: For olfaction, several studies have reported near-infrared spectroscopy (NIRS) signal changes in the orbitofrontal cortex (OFC) during odor stimulation. However, the roles of human OFC in olfactory cognition are less well understood. This study was designed to better understand the roles of OFC for olfaction. METHODS: Hemodynamic responses for phenyl ethyl alcohol or citral in the OFCs were measured with NIRS. After the experiment, participants were asked to describe the characteristics of the odor and to rate odor intensity and hedonic valence. RESULTS: Statistical analysis of all participants' data showed significant changes in the concentration of total hemoglobin in the left OFC during the trial (p = 0.04). The total hemoglobin signal increased significantly in the right OFC (p = 0.0008) of the participants who successfully identified the odorant stimulus. CONCLUSION: Our findings showed that NIRS combined with a questionnaire is a useful method for studying the functional neuroanatomy of OFC in terms of olfaction.