We analyzed 356 patients with idiopathic sudden sensorineural hearing loss treated with hyperbaric oxygen therapy and systemic steroids (<i>n</i> = 161), systemic steroids alone (<i>n</i> = 160), or intratympanic and systemic steroids (<i>n</i> = 35). The main outcome measure was the hearing recovery rate. The effect of other variables, including the initial averaged 5-frequency hearing level, patient age, interval between the onset of symptoms and treatment, presence of vertigo as a complication, presence of diabetes mellitus, smoking history, and presence of hypertension, on the hearing recovery rate was also evaluated. The overall hearing recovery rate was significantly higher for the patients treated with hyperbaric oxygen therapy and systemic steroids than for those treated with systemic steroids alone (<i>p</i> < 0.001) or systemic and intratympanic steroids (<i>p</i> < 0.001). The presence of vertigo negatively affected hearing recovery. Our findings suggest that hyperbaric oxygen therapy confers a significant additional therapeutic benefit when used in combination with steroid therapy for idiopathic sudden sensorineural hearing loss.
We encountered two cases of refractory sniff-type patulous Eustachian tubes. Case 1, a 14-year-old girl visited our hospital with the chief complaint of “aural fullness”. The diagnosis of patulous Eustachian tube was made according to the diagnostic criteria for this condition. Conservative treatments, such as oral medicines, instillation of physiological saline, and application of adhesive tape on the tympanic membrane proved ineffective, and we performed ventilation tube insertion. Immediately after placement of the ventilation tube, the patient developed “auditory hyperacusis” (hypersensitivity to surrounding sounds), but this improved from the 16th day after insertion. Wearing earplugs was effective during this period when environmental noise was particularly noticeable. With the improvement of the auditory hyperacusis, the aural fullness also improved. It is important to explain to the patients about the possible development of auditory hyperacusis before the ventilation tube insertion. Case 2 was a 31-year-old woman with the chief complaint of “autophonia”. She also had anorexia nervosa. The diagnosis of patulous Eustachian tube was made according to the diagnostic criteria for this condition. We considered that the “sound invasion into the middle ear” had a greater effect on the pathology than the “pressure change in the middle ear” in this case, and inserted Kobayashi plugs into the Eustachian tube. We also inserted a ventilation tube in anticipation of continued sniffing and worsening of the tympanic membrane retraction due to negative pressure. Thereafter, the patient exhibited the behavior of sniffing while inserting a finger into the external auditory meatus, but we considered that there was no direct effect on the tympanic membrane. The Kobayashi plugs were replaced (sized up) during follow-up, and the ear symptoms, mainly autophonia, resolved.
Abstract Objectives: Pendred syndrome is inherited as an autosomal recessive form and may account for 10% of hereditary hearing loss. It is likely that there is a great variation in hearing loss. We report a case of Pendred syndrome in which a mutation in SLC26A4 gene was detected and show the characteristics of long-term audiological changes. Methods: A 27-year-old woman was followed since March 1979 at Hamamatsu University School of Medicine. She first experienced vertigo at the age of 1 1/2 years and her parents were concerned about her poor response to sound. Mild hearing loss was diagnosed in another clinic at the age of 4 years. Results: Long-term audiological observation over 20 years showed that a 45 dB in the right ear and 41.2 dB in the left ear increased as the average threshold with fluctuation and marked progression combined with vertigo occurred before the age of 12. After that, the threshold moved to the stable. The audiogram indicated an asymmetric pattern and sensorineural hearing loss predominantly. A caloric test revealed a normal response on both sides. Corticosteroids were not effective in improving hearing loss. A diffuse goiter was noticed at the age of 15 years. The goiter slightly enlarged over the 12 years follow-up period. Conclusion: Although the His723Arg missense mutation is a change at unconserved position in the pendrin protein, it is a pathological mutation in our case because it was found in the homozygous state. It is possible that different mutations within the same gene lead to different phenotypes.
Eighteen cases of tuberculosis of the head and neck region are reported.1) Fourteen of the 18 patients had cervical lymphnode tuberculosis, 2 had tuberculous otitis media and 2 had tuberculosis of the larynx.2) Recently, cervical lymphnode tuberculosis has become uncommon, but it is important to differentiate it from malignancy by histopathological and bacteriological studies.3) Fine needle aspiration biopsy (FNA), performed in 9 cases, was positive in 7 cases (77.8%).We conclude that FNA is useful in the diagnosis of cervical lymphnode tuberculosis.
Human papilloma virus (HPV) has been identified in the upper aerodigestive tract tissue, giving a clue to the etiology of tumorigenesis. Moreover, HPV-16, 18 and 33 have the ability to transform cells and HPV-16 and 18 especially, are closely associated with head and neck cancers. p 53 tumor suppressor gene is known to be inhibited by binding with HPV-E6 protein. The number of young patients with tongue cancer has been increased. In this study we investigated the association of HPV with p 53 expression in tongue cancer patients. The patients were divided into two groups (group 1: less than 40 years old, group 2 : more than 70 years old). HPV-DNA was detected in one of 12 patients in group 1, and in none of the 12 patients in group 2 by in situ hybridization. Overexpression of p 53 in group 1(7112) was significantly higher than that in group 2 (2112). Our data suggests that HPV might be one of factors in the transformation of tongue cancr. To eliminate this possibility, however, it is necessary to carry out other methods of molecular biological investigation (e. g. PCR or in situ PCR) in a much larger number of cases.
