Prediction of hearing outcomes by distortion product otoacoustic emissions in patients with idiopathic sudden sensorineural hearing loss.

OBJECTIVE: To investigate whether distortion product otoacoustic emissions (DPOAEs) can be a prognostic indicator of hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Seventy-eight consecutive patients with ISSNHL were enrolled. DPOAEs were measured at the first hospital visit. Two primary pure tones with a frequency ratio (f2/f1) of 1.2 were used at non-equal sound pressure levels (L1/L2=80/70dB SPL). The DPOAE amplitude was measured at the 11 frequencies of 2f1-f2 with f2 varying from 593 to 6031Hz. All the patients received steroid administration in combination with hyperbaric oxygen (HBO) therapy. Hearing recovery was evaluated by the improvement in hearing compared to the unaffected contralateral ear. Correlations between the hearing improvement rate and five potential prognostic factors (the DPOAE amplitude, patient's age, days from onset to the start of treatment, initial hearing level, and presence of vertigo) were examined by simple and multiple regression analyses. RESULTS: The net DPOAE amplitude in patients with hearing improvement rate ≥50% was significantly larger than that with hearing improvement rate <50% at f2 frequencies of 3031 and 4812Hz (unpaired Student's t-test, p<0.05). A simple regression analysis showed that the hearing improvement rate significantly correlated with the net DPOAE amplitude at f2 frequencies of 3031 and 4812Hz, but not with that at the other f2 frequencies tested. The correlation coefficients were 0.528 and 0.522 for 3031 and 4812Hz, respectively, with p values <1×10(-6). In a multiple regression analysis, the partial correlation coefficients of the net DPOAE amplitude were 0.308 and 0.246 with p values of 0.008 and 0.036 for 3031 and 4812Hz, respectively. CONCLUSION: The significant correlation between hearing recovery and DPOAEs measured before treatment indicates that DPOAEs are a potentially useful means of predicting hearing prognosis in ISSNHL.

[Screening of sleep apnea syndrome with Sleeprecorder SD-101].

Polysomnography (PSG) has been the gold standard for the diagnosis of sleep apnea syndrome (SAS). However, PSG is not generally available since it is technically demanding, and cost and labour are necessary. Currently, there is growing demand for its diagnosis. Thus, simplified portable equipments have been increasingly utilized. Sleeprecorder SD-101 (Suzuken, Nagoya, Japan) is a pad-shaped and novel device for SAS analysis. A total of 162 sitting-sensor tips are 1.6 inch apart, embeded in the 55 x 22 inch pad, and capable of detecting load with precision of one gram. Sleeprecorder SD-101 placed beneath the chest can recognize respiratory pattern and record thoracic movement during sleep. SASLyzer (Suzuken, Nagoya, Japan), a software installed in a compatible PC, analyzes the data and indicates apnea-hypopnea index (AHI). We present a case of SAS in a 40-year-old man (181 cm, 98 kg) with peritonsillitis. We used Sleeprecorder SD-101 since he complained of severe snoring and excessive daytime sleepiness. He had severe SAS with AHI 50.7. Subsequently, conventional PSG also indicated AHI 77. In the present case with severe SAS, these two methods showed equivalent severity. Sleeprecorder SD-101 could be a useful device for screening of SAS patients.

[Usefulness of cephalometry and pharyngeal findings in the primary diagnosis of obstructive sleep apnea syndrome].

We studied the usefulness of cephalometry and pharyngeal findings in determining efficient primary diagnosis of obstructive sleep apnea syndrome (OSAS). Subjects were 171 adult men with sleep-disordered breathing, who underwent cephalometry and polysomnography (PSG) and had pharyngeal findings evaluated by modified Mallampati grade (MMP) and palatine tonsil size. An apnea-hypopnea index (AHI) of > or = 15 in PSG was considered to indicate OSAS. We analyzed the correlation between AHI and other parameters and conducted stepwise multiple regression analysis to predict AHI, and studied the screening performance of prediction equations using a receiver operating characteristic (ROC) curve. Of the 8 cephalometric parameters examined, the length of the soft palate (PNS-P; p = 0.011) and the distance from the mandibular plane to the hyoid bone (MP-H; p < 0.001) correlated significantly with AHI. Two indices of the pharyngeal finding and body mass index (BMI) also significantly correlated with the AHI (MMP; p < 0.001, tonsil size; p = 0.005, BMI; p < 0.001). We next set up three prediction equations including (a) two significant cephalometric parameters (PNS-P and MP-H), (b) two pharyngeal indices (MMP and tonsil size), or (c) both. BMI was included in all three. ROC curve analysis showed that the screening performance of prediction equations was (c) > (a) > (b). Sensitivity and of equation (c) with a cutoff of 15 were 0.95 and specificity 0.25. These results indicate that both cephalometric parameters and pharyngeal indices should be included in conducting an efficient primary diagnosis for OSAS.

Snoring, daytime sleepiness, and nasal obstruction with or without allergic rhinitis.

OBJECTIVE: To investigate the relationships among nasal obstruction (NO), snoring, and excessive daytime sleepiness (EDS) in working people with or without allergic rhinitis (AR). DESIGN: Prospective study using questionnaires. SETTING: An industrial company in Japan. PARTICIPANTS: We asked 1878 daytime workers to complete questionnaires; data from 1459 respondents were analyzed. Participants were divided into 3 groups: those with NO plus AR, those with NO without AR, and those with AR without NO. Individuals without NO or AR served as controls. MAIN OUTCOME MEASURES: Allergic rhinitis and daytime sleepiness were evaluated using the European Community Respiratory Health Survey questionnaire and the Epworth Sleepiness Scale, respectively. RESULTS: The percentage of snorers, the Epworth Sleepiness Scale score, and the percentage of participants with EDS were higher in the NO-AR and NO groups but were not significantly different in the AR group compared with the control group. These variables did not differ between the NO-AR and NO groups. Patients in the NO-AR and NO groups had higher odds of snoring and of having EDS, whereas the odds of snoring or of having EDS were not statistically significant in the AR group compared with the control group (P = .67 and P = .3, respectively). CONCLUSIONS: Nasal obstruction is associated with snoring and EDS in individuals with or without AR. Allergic rhinitis without NO is not associated with sleep-disordered breathing or EDS.

Digastric muscle sew-up procedure for the repair of the floor of the mouth following pull-through operation for oral cancers.

OBJECTIVES: We report the digastric muscle sew-up procedure for the repair of the floor of the mouth following the pull-through operation for advanced oral cancers. METHODS: Eleven patients with advanced oral cancers (of the tongue in 8 cases and of the floor of the mouth in 3 cases) were retrospectively analyzed. One-third glossectomy and hemiglossectomy were performed in 4 patients each; the other 3 patients underwent tumor resection on the floor of the mouth. After neck dissection and tumor resection via the pull-through approach, the floor of the mouth was repaired simply by sewing the digastric muscle to the mandibular base. The surfaces of the transected musculature of the tongue and the floor of the mouth were left uncovered and exposed to the oral cavity. RESULTS: The postoperative wound healing was fairly good in all of the patients. Neck infection or the formation of a fistula on the floor of the mouth was not seen. The patients started transoral ingestion by the 10th postoperative day. Temporary difficulty in swallowing occurred in all patients, but was totally alleviated within 1 month. Their clarity of speech recovered to a tolerable level. CONCLUSIONS: We believe that the digastric muscle sew-up procedure is a simple, safe, and timesaving method for the repair of small to medium-sized defects of the floor of the mouth created by ablative surgery in patients with advanced oral cancers.

Immunoreactivities for glutathione S-transferases and glutathione peroxidase in the lateral wall of pigmented and albino guinea pig cochlea.

Dark-skinned people are known to be more tolerant of ototraumatic noise than are light-skinned people, and pigmented animals are more tolerant of ototraumatic noise and aminoglycoside ototoxicity than are albino animals. Such tolerance may be dependent on the local ability of detoxification and antioxidant enzymes, including glutathione S-transferase (GST) and glutathione peroxidase (GSPx). In the present study, we examined the difference in GST/GSPx expression in the lateral wall of the cochlea between pigmented and albino guinea pigs. Eight-week-old male pigmented and albino guinea pigs were killed by transcardiac perfusion with 2% paraformaldehyde. The cochlear ducts were isolated, further fixed with 4% paraformaldehyde, decalcified, and then embedded in paraffin. Sections prepared at 5-microm thickness were incubated with anti-GST-alpha,-mu,-pi, or anti-GSPx antibody, reacted with Alexa Fluorconjugated secondary antibody, and examined under a Carl Zeiss Axioskop 2 plus fluorescence microscope. The cochlea ducts were also subjected to immunoelectron microscopy for GST-pi by the postembedment method. The stria vascularis of pigmented guinea pigs was strongly immunoreactive for GST-alpha,-mu,-pi, and GSPx, whereas no or only weak immunoreactivities were seen in the stria vascularis of albino guinea pigs. The spiral ligament showed positive but different immunoreactivities for these enzymes between the strains. Double-stained immunofluorescence micrographs for GST-pi and GSPx showed a close resemblance of localization between the two enzymes in both pigmented and albino guinea pigs. At the ultrastructural level, immunoreactivity for GST-pi was localized preferentially in the melanin cells of pigmented guinea pigs. These results suggest that correlation between pigmentation and inner ear susceptibility is, at least partially, attributed to the different distribution of GST/GSPx in the stria vascularis.

Concurrent hyperfractionated radiotherapy and carboplatin with transoral debulking microsurgery for T2N0 glottic cancer.

BACKGROUND: Our aim was to evaluate the efficacy and toxicity of chemoradiotherapy (CRT) with transoral debulking microsurgery for T2N0 glottic cancer. METHODS: Thirty patients with T2N0 glottic cancer treated with concurrent hyperfractionated radiotherapy (RT) and carboplatin were retrospectively analyzed. Median total dose of RT was 72 Gy. Nineteen of 30 patients also received transoral debulking microsurgery during or before CRT. The remaining 11 patients who demonstrated complete response or good partial response at 36 to 45.6 Gy were not treated with transoral debulking microsurgery. RESULTS: Local recurrence developed in 5 patients; 4 of these patients did not undergo transoral debulking microsurgery. The 3-year local control rate was significantly better for CRT with transoral debulking microsurgery (95%) than for CRT alone (61%) (p = .02). CONCLUSION: CRT with transoral debulking microsurgery may have a positive impact on the local control of T2N0 glottic cancer, which justifies further evaluation to confirm its definite benefit.

Nasopharyngeal Haemophilus influenzae carriage in Japanese children attending day-care centers.

We conducted a prospective bacteriological survey to investigate antibiotic resistance-related genetic characteristics and the turnover of nasopharyngeal Haemophilus influenzae carriage in healthy children in day-care centers (DCCs). A total of 363 nasopharyngeal mucus samples were collected from children aged 0 to 6 years attending two DCCs in the summer of 2004 (n = 184) and the following winter (n = 179). We obtained 172 H. influenzae isolates and analyzed them by antimicrobial susceptibility testing, PCR for bla(TEM-1) and the penicillin-binding protein (PBP) gene, and pulsed-field gel electrophoresis (PFGE). The overall carriage rate was 47.4% (172/363), and 37.2% of the isolates (64/172) were ampicillin (AMP) resistant. All the resistant isolates had a PBP mutation(s), while only three isolates had TEM-1. The carriage rate was significantly higher in the winter than in the summer (56.4% and 38.6%, respectively), owing to the increase in the numbers of AMP-susceptible H. influenzae isolates in the winter. Children aged < or = 3 years showed a higher rate of carriage of H. influenzae isolates with an AMP resistance gene(s) than those aged > or = 4 years (21.9% and 12.6%, respectively). Forty-two strains with different PFGE patterns were obtained from among the 172 isolates. Only five strains were observed in both seasons. None of the strains isolated in the summer was isolated from the same carrier in the winter. Twenty-seven strains (64.3%) were isolated from two or more children, and 25 of these were each isolated from children belonging to the same DCC. These results indicate the spread of H. influenzae, particularly those with a PBP mutation(s), and the highly vigorous genetic turnover and substantial horizontal transmission of this pathogen in healthy children attending DCCs in Japan.

Prostaglandin E1 versus steroid in combination with hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss.

OBJECTIVE: We conducted a controlled retrospective analysis of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) in order to investigate the effect of prostaglandin E1 (PGE1) plus hyperbaric oxygen (HBO) therapy in comparison with that of steroid plus HBO therapy. METHODS: One hundred and ninety-six consecutive patients with ISSNHL (hearing levels > or ==40dB; time from the onset of hearing loss to the start of treatment < or ==30 days) were enrolled. Ninety-five patients underwent PGE1 plus HBO therapy (PG group) and 101 underwent steroid administration plus HBO therapy (steroid group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to the unaffected contralateral ear. RESULTS: The hearing levels after treatment were 52.2+/-3.0 and 47.5+/-2.8dB, the hearing gains were 31.3+/-2.2 and 27.2+/-2.3dB, the cure rates were 28.4% and 28.7%, the recovery rates were 54.7% and 53.5%, and the hearing improvement rates were 48.4+/-5.1% and 53.9+/-4.2% in the PG and steroid groups, respectively. There were no significant differences between the two groups. CONCLUSION: We concluded that PGE1 and a steroid are equally effective in the treatment of ISSNHL when used together with HBO therapy. PGE1 plus HBO therapy can be one of the potential alternative treatments for ISSNHL, particularly in steroid-intolerant patients such as those with severe diabetes mellitus, an active peptic ulcer, or viral hepatitis.

Prostaglandin E1 in combination with hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss.

CONCLUSIONS: Prostaglandin E1 (PGE1) is less effective than stellate ganglion block (SGB) in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) patients with severe hearing losses when used together with hyperbaric oxygen (HBO) therapy. In contrast with the systemic action of intravenous PGE1, SGB's localized vasodilating action may explain its advantage over intravenous PGE1. OBJECTIVES: To investigate the effect of PGE1 plus HBO therapy on ISSNHL in comparison with that of SGB plus HBO therapy. PATIENTS AND METHODS: We retrospectively analyzed 205 consecutive patients with ISSNHL (hearing levels > or = 40 dB; time from the onset of hearing loss to the start of treatment < or = 30 days). Ninety-five patients underwent intravenous PGE1 plus HBO therapy (PG group) and 110 underwent SGB plus HBO therapy (SGB group). Hearing recovery was evaluated by grade assessment and by hearing improvement compared to that in the unaffected contralateral ear. RESULTS: The overall hearing outcome was not statistically different between the two groups. For patients with initial hearing levels <80 dB, the groups had roughly equivalent hearing outcomes, whereas in patients with initial hearing levels > or = 80 dB, the hearing improvement rate was significantly higher in the SGB group than in the PG group (53.0 +/- 5.0% vs 35.3 +/- 6.8%; p <0.05).

Endoscopic sinus surgery for the treatment of organized hematoma of the maxillary sinus.

Organized hematoma is a benign and non-neoplastic lesion, however, differential diagnosis from neoplastic diseases is always problematic, and patients are often forced to sustain excessive surgical invasion. We retrospectively studied the characteristics of imaging findings of organized hematoma of the maxillary sinus, and estimated the validity and effectiveness of endoscopic sinus surgery for the treatment of this disease. Three patients (2 men and a woman, ranging in age from 50 to 62 years) with organized hematoma of the maxillary sinus who underwent endoscopic sinus surgery were retrospectively analyzed. The diagnosis was provisionally made based on the findings of preoperative computed tomography (CT) and magnetic resonance imaging (MRI), and was confirmed by histopathological examinations of surgical specimens. CT revealed a well-defined expansile mass in the unilateral sinus associated with thinning and expansion of the medial sinus wall in all the cases. On contrast-enhanced images, patchy heterogeneous enhancement was observed. Intermingled low/intermediate/high signal intensity was seen on both T1- and T2-weighted MRI. The lesions were curetted via an endoscopic middle meatal antrostomy with the assistance of a microdebrider. None of the patients received arterial embolization or blood transfusion. Histopathological findings were consistent with those of organized hematoma. Their postoperative courses were uneventful, and all the patients are currently free from disease. We conclude that organized hematoma of the maxillary sinus can be successfully treated by endoscopic sinus surgery under accurate preoperative diagnosis and careful surgical planning.

Chronic nasal obstruction causes daytime sleepiness and decreased quality of life even in the absence of snoring.

BACKGROUND: There has been a growing awareness that nasal obstruction may impair various daily and social activities. We performed a questionnaire survey in a working population to clarify the contribution made by snoring concomitant with nasal obstruction to daytime sleepiness and quality of life (QOL). METHODS: Seven thousand nine hundred eighty daytime workers were asked to complete questionnaires, 7702 responded, and the data from 3442 subjects were finally analyzed. Nasal obstruction and snoring were graded into three and four categories, respectively. Daytime sleepiness and QOL were assessed by the Epworth Sleepiness Scale (ESS) and the Medical Outcomes Study 36-Item Short-Form Health Survey, respectively. RESULTS: Subjects with chronic nasal obstruction, even if snoring was absent, reported significantly higher ESS scores and lower QOL scores than control subjects, and the presence of habitual snoring had an additive influence on these changes. The ESS and mental QOL scores adjusted for age, sex, and body mass index showed the same tendency. CONCLUSION: Induction of sleep-disordered breathing (SDB) is a possible cause of excessive daytime sleepiness and impaired QOL in subjects with nasal obstruction. A variant of SDB such as silent upper respiratory resistance syndrome may participate in this phenomenon in the absence of snoring.

Relationships between nasal obstruction, observed apnea, and daytime sleepiness.

OBJECTIVE: We administered a questionnaire survey to a working population in an attempt to clarify the relationships between self-reported nasal obstruction, observed apnea during sleep, and daytime sleepiness. STUDY DESIGN: A total of 7980 daytime workers were asked to complete questionnaires about nasal obstruction, apnea during sleep, and daytime sleepiness. Of the 7702 responses, the data from 4818 subjects were analyzed. Nasal obstruction and observed apnea were graded into 3 categories. Daytime sleepiness was assessed by the Epworth Sleepiness Scale. RESULTS: Subjects with chronic nasal obstruction had 5.22 and 2.17 times higher odds for having habitual observed apnea and excessive daytime sleepiness (EDS), respectively, compared with those without nasal obstruction (P < 0.001). After adjusting for 3 potential confounding factors (age, sex, and body mass index) and the presence of habitual observed apnea, odds ratios for having EDS decreased, but still remained significant. CONCLUSION: Nasal obstruction is likely to cause daytime sleepiness, at least in part, by causing sleep-disordered breathing including apnea during sleep.

[Clinical study of early laryngeal cancer].

We retrospectively analyzed 71 consecutive cases of early laryngeal cancer (stage I or II) that had undergone primary treatment in our department between 1999 and 2004. There were 68 males and 3 females, and their ages ranged from 40 to 85 years of age (average; 67.7 years). Eight patients had the supraglottic type, 61 had the glottic type, and 2 had the subglottic type. Chemoradiotherapy was performed as the primary treatment except in the patients with glottic T1a cancer, who received radiotherapy alone. The 5-year survival rates was 91.1% for glottic cancer (T1a: 100%, T1b: 92.3%, T2: 85.8%) and 75.0% for supraglottic cancer. The local control rate of glottic cancer was 79.6% (T1a: 80.0%, T1b: 74.0%, T2: 85.2%), and significantly higher than that of supraglottic cancer (56.2%, p < 0.05). The laryngeal preservation rate was 84.4% in glottic cancer (T1a: 100%, T1b: 76.9%, T2: 77.5%) and 58.3% in supraglottic cancer, and the difference between T1a and T2 glottic cancer was significant (p < 0.05). Local recurrence and cervical lymph node metastasis were seen in 9 patients and 6 patients, respectively. Distant metastasis occurred in 4 patients, all of whom had the glottic type. Four patients died of their disease, and distant metastasis was the major cause of death in 3 of them. These results indicate that additional treatment should be performed in cases in which radiotherapy/chemoradiotherapy is ineffective and that both in the early stages glottic and supraglottic cancers can be successfully treated by radiotherapy/chemoradiotherapy. The results also suggested that the survival of patients with early laryngeal cancer depends on whether they develop distant metastasis. Introduction of adjuvant chemotherapy to improve their prognosis remains to be assessed.

[Evaluation of quality of life in patients with allergic rhinitis].

Nasal symptoms of allergic rhinitis, such as watery rhinorrhea, sneezing and nasal obstruction, are thought to result in reduction in quality of life (QOL). In this study, we evaluated the QOL scores of patients suffering from allergic rhinitis, using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and the Short Form-36 (SF-36). One hundred twenty six patients with allergic rhinitis who visited the department of otolaryngology of UOEH and affiliated hospitals from April, 2003 to March, 2004 were enrolled in this study. Each symptom of allergic rhinitis was shown to degrade the RQLQ scores. In particular, nasal obstruction and severity of the disease strongly related to the RQLQ scores. All the SF-36 scores of allergic rhinitis patients were lower than those of standard Japanese. Nasal obstruction was severer, and ocular symptoms were milder in the perennial group than in the seasonal group. The QOL scores of emotional aspects were significantly different between generations. The QOL score of social functioning increased, and that of mental health decreased with age. These results clearly indicate that nasal symptoms of allergic rhinitis cause degradation of QOL in daily and social lives. It would be interesting and necessary to evaluate QOL disturbance and loss of working efficiency in workers with allergic rhinitis in further studies.

Oncocytic schneiderian papilloma confined to the sphenoid sinus detected by FDG-PET.

We report a 55-year-old man with oncocytic schneiderian papilloma confined to the sphenoid sinus, which was initially detected by positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) at a very early stage. Based on CT and MRI findings, we suspected that the tumor was most likely benign; however, positive uptake in FDG-PET suggested malignancy. The patient underwent endoscopic resection of the tumor, and the histopathological diagnosis turned out to be oncocytic schneiderian papilloma. FDG-PET is thought to be a powerful tool to search for malignant lesions, but the present case demonstrates the fallibility of this technique. This should be taken into consideration when interpreting FDG-PET images.

Clinical features of head and neck cancer patients with methicillin-resistant Staphylococcus aureus.

CONCLUSIONS: The risk factors for methicillin-resistant Staphylococcus aureus (MRSA) detection in head and neck cancer patients are the duration of hospitalization, intravenous hyperalimentation, prior antibiotic use, and the coexistence of other pathogens. OBJECTIVES: To shed light on the clinical characteristics of MRSA-positive inpatients with head and neck cancers. The secondary goal was to evaluate risk factors for MRSA detection in comparison with methicillin-sensitive S. aureus (MSSA). PATIENTS AND METHODS: Sixty-one consecutive inpatients with head and neck cancers with S. aureus detection were analyzed based on their medical records. The antimicrobial susceptibility of isolated S. aureus was tested by the broth microdilution method. RESULTS: MRSA and MSSA were detected in 46 (75.4%) and 15 (24.6%) of the 61 patients, respectively. There was no significant difference in the male/female ratio, age, primary site, comorbidity, cancer stage, cancer treatment, or 5-year survival rate between the MRSA and MSSA groups. Compared with the MSSA group, the MRSA group had significantly longer hospitalization periods and intervals between admission and MRSA detection, as well as significantly greater likelihood of intravenous hyperalimentation, prior antibiotic use, and co-isolation of other pathogens. Isolated strains of MRSA were thoroughly sensitive to vancomycin and arbekacin and moderately sensitive to minocycline.

Hyperbaric oxygen and steroid therapy for idiopathic sudden sensorineural hearing loss.

In our controlled retrospective analysis of medical records in tertiary care academic medical center, we aimed to investigate the therapeutic effects of hyperbaric oxygen (HBO) therapy combined with steroid administration for idiopathic sudden sensorineural hearing loss (ISSNHL) in comparison with that of steroid administration alone. Our subjects were 130 consecutive inpatients with ISSNHL (hearing levels >/=40 dB; time from the onset of hearing loss to the start of treatment /=80 dB, the hearing improvement rate was significantly higher in the HBO group than in the steroid group (51.1 +/- 7.0% vs. 27.1 +/- 7.8%; P < 0.05), while in patients whose initial hearing levels were <80 dB, hearing outcomes were not statistically different between the two groups. In both the HBO and steroid groups, patients with initial hearing levels of <80 dB showed a better hearing improvement rate than those with initial hearing levels of >/=80 dB. In conclusion HBO therapy shows a significant additional effect in combination with steroid therapy for ISSNHL, particularly in patients with severe hearing loss.

Eikenella corrodens in head and neck infections.

BACKGROUND: Eikenella corrodens (E. corrodens) is a Gram-negative facultative anaerobic bacillus that originally was thought to be an attenuated and indigenous bacterium. In recent years, a number of reports have documented that E. corrodens can be a potential pathogen not only in immunocompromised patients but also in hosts with normal immunity. We herein study E. corrodens infections of the head and neck encountered in our department. METHODS: Twenty-two consecutive patients treated in our department for E. corrodens infections of the head and neck were retrospectively analyzed. Microbial specimens were subjected to light microscopic examination, aerobic culture using chocolate and sheep blood agar media, and anaerobic culture using Brucella HK agar medium. Cultured bacteria were subjected to antimicrobial susceptibility tests by means of the broth microdilution method. RESULTS: There were 16 males and 6 females with an average age of 29.9 years. Two patients had malignancy, while the other patients had no particular risk factors or underlying diseases. Infected sites were the ear in 6 cases, pharynx in 12 cases (tonsil in 10 cases), paranasal sinuses in 3 cases, and salivary gland in 1 case. Seventeen patients suffered polymicrobial infections. Staphylococcus and Streptococcus were the most frequently detected pathogens coexisting with E. corrodens, and mixed infections of E. corrodens and Streptococcus milleri group bacteria were prone to form abscesses. Isolated E. corrodens was susceptible to third-generation cephems (MIC90 = 0.15-0.25 microg/ml), carbapenems (MIC90 < or = 0.15 microg/ml), and new quinolones (MIC90 < or = 0.15 microg/ml), and resistant to oxacillin (MIC90 > 8 microg/ml), cefazolin (MIC90 > 4 microg/ml), macrolides (MIC90 = 4-8 microg/ml), and clindamycin (MIC90 > 4 microg/ml). CONCLUSIONS: E. corrodens infections of the head and neck occur most frequently in the tonsil even in hosts with normal immunity. Coexistence with Streptococcus milleri group bacteria and the use of ineffective antibiotics can be exacerbating factors. First-choice drugs for E. corrodens infections should be third-generation cephems, carbapenems, or new quinolones.

Association of verrucous carcinoma and inverted papilloma in the sinonasal tract.

It is well known that inverted papilloma (IP) is sometimes associated with malignancies; however, the association of IP with verrucous carcinoma (VC) is extremely rare. We herein report a case of IP in the nasal cavity with VC in the maxillary sinus. A 73-year-old Japanese woman presented with a 3-month history of right-sided nasal obstruction and repetitive epistaxis. A biopsy of the mass was performed and the pathological result proved to be IP. Computed tomography and magnetic resonance imaging revealed a moderately enhanced soft-tissue lesion filling the right nasal cavity and a ring-enhanced expansive lesion in the maxillary sinus. Under a tentative diagnosis of IP of the nasal cavity with maxillary empyema, she underwent right medial maxillectomy via a lateral rhinotomy approach, and a histopathological diagnosis of IP in the nasal cavity with VC in the maxillary sinus was obtained. Her postoperative clinical course was uneventful. She is currently free from symptoms, and there is no evidence of recurrence 5 months after surgery. The pathology, clinical manifestation, and treatment of VC associated with IP are reviewed from literature.