This study examines the long-term stability of otoacoustic emissions (OAEs), and we selected click-evoked otoacoustic emissions (CEOAEs) and distortion product otoacoustic emissions (DPOAEs) from several types of OAEs. We then compared these methods for the long-term monitoring of inner ear functions. Over a period of 8 weeks, we measured CEOAEs and DPOAEs in guinea pigs (n = 8) every week and analyzed the changes in the total echo power of CEOAE, the echo power of frequency bands of CEOAE and the DPOAE level (f2/f1 = 1.2). We considered as ‘stable’ parameters those that showed small changes or of which the p value was close to 1.0. Good p values of CEOAEs were obtained over the 2- to 3-kHz range; better p values of DPOAEs were obtained over the 2- to 8-kHz range. Thus, DPOAEs afforded the extended frequency information achievable with CEOAEs. According to our results, DPOAEs were superior to CEOAEs as parameters of long-term stability because they showed fewer changes in level at each frequency.
Non-invasive surface recording devices used for detecting swallowing events include electromyography (EMG), sound, and bioimpedance. However, to our knowledge there are no comparative studies in which these waveforms were recorded simultaneously. We assessed the accuracy and efficiency of high-resolution manometry (HRM) topography, EMG, sound, and bioimpedance waveforms, for identifying swallowing events.Six participants randomly performed saliva swallow or vocalization of "ah" 62 times. Pharyngeal pressure data were obtained using an HRM catheter. EMG, sound, and bioimpedance data were recorded using surface devices on the neck. Six examiners independently judged whether the four measurement tools indicated a saliva swallow or vocalization. Statistical analyses included the Cochrane's Q test with Bonferroni correction and the Fleiss' kappa coefficient.Classification accuracy was significantly different between the four measurement methods (P < 0.001). The highest classification accuracy was for HRM topography (>99%), followed by sound and bioimpedance waveforms (98%), then EMG waveform (97%). The Fleiss' kappa value was highest for HRM topography, followed by bioimpedance, sound, and then EMG waveforms. Classification accuracy of the EMG waveform showed the greatest difference between certified otorhinolaryngologists (experienced examiners) and non-physicians (naive examiners).HRM, EMG, sound, and bioimpedance have fairly reliable discrimination capabilities for swallowing and non-swallowing events. User experience with EMG may increase identification and interrater reliability. Non-invasive sound, bioimpedance, and EMG are potential methods for counting swallowing events in screening for dysphagia, although further study is needed.
Recently, there have been many reports of intratympanic gentamicin therapy for the treatment of intractable Meniere's disease. Intratympanic administration of steroids has also been used to treat sudden sensorineural hearing loss. We attempted to visualize how the intratympanically administered drug enters the inner ear.Gadolinium hydrate diluted eightfold with saline was injected intratympanically through the tympanic membrane using a 23 G needle in nine patients with inner ear diseases. With a 3 Tesla magnetic resonance imaging (MRI) unit, three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) imaging was performed.3D-FLAIR MRI clearly revealed that the gadolinium entered the perilymphatic space and delineated the perilymphatic and endolymphatic spaces of the inner ear. In patients with endolymphatic hydrops, the perilymphatic space surrounding the endolymph was small or had disappeared. Gadolinium appeared first in the scala tympani of the basal turn of the cochlea and the perilymphatic space of the vestibule. One day after the intratympanic injection of gadolinium, the gadolinium was observed in almost all parts of the perilymph. Six days after the intratympanic injection, the gadolinium had almost disappeared from the inner ear.We reported the first visualization of endolymphatic hydrops in patients with Meniere's disease. The relationship between the image of the endolymphatic space and functional tests, such as electrocochleography and vestibular-evoked myogenic potential, must be examined in the near future. It is important for the development of intratympanic drug therapies for inner-ear diseases to investigate how the drugs enter and leave the inner ear.
Conclusion: Persistent obstructive sleep apnoea syndrome (OSAS) occurs in approximately 20% of normal-weight children after adenotonsillectomy (T&A) and, in nearly 70% of them, it is caused by adenoid regrowth. Patients with severe or moderate OSAS showed a high incidence of persistent disease even after T&A. Allergic disease, severity and large adenoid size are associated with adenoid regrowth and persistent disease. Objectives: To investigate factors contributing to persistent OSAS and adenoid regrowth after T&A in normal-weight children. Methods: This was a prospective, observational study at a single institute and involved 49 normal-weight children with severe or moderate OSAS (apnoea–hypopnoea index, AHI, ≥ 5) who underwent T&A. Background information, nasal endoscopic data and pre- and postoperative polysomnographic data were collected. A third polysomnography (PSG) was performed 1.5 year postoperatively in children who subsequently developed symptoms of sleep disturbance. Results: Thirteen children (27%, 13/49) were symptomatic 1.5 years after T&A. Allergic rhinitis (38.5% vs 11.1%, p = 0.03) and allergic disease (69.2% vs 30.6%, p = 0.02) were seen more frequently in these children. A third PSG confirmed persistent disease (AHI ≥ 5) in nine children (18.4%, 9/49). Six children (12.2%, 6/49) were diagnosed as having adenoid regrowth and three (6.1%, 3/49) underwent revision adenoidectomy.
Rupture of the common carotid artery is one of the most feared postoperative complications of neck dissection.A 55-year-old-male patient with carcinoma of the hypopharynx (T4N2CM0) underwent a total pharyngolaryngoesophagectomy, radical neck dissection on the right side and conservative neck dissection on the left side. Ten days later the right common carotid artery ruptured. We suspect that the artery rupture was secondary to MRSA infection.Ligation of right common carotid artery was performed and the patient survived without neurological problems. In order to determine the safety of resection of a common carotid artery, we measured stump pressure and monitored electroencephalogram changes during surgery.The incidence and risk factors of carotid artery rupture are discussed. To our knowledge, this is the first report of carotid artery rupture due to MRSA infection.
The first patient was a 56-year-old female with a solitary mass of the right parotid gland. The second patient was a 74-year-old female with a solitary mass of the right parotid gland. The third patient was a 60-year-old male with a solitary mass of the left parotid gland. Sjögren's syndrome was present only in the first patient. CT scans and echograms demonstrated a well-circumscribed mass in all three, and we treated and removed these lesions as a parotid tumor. The pathological findings in all three resected tumors were atrophy of the glandular parenchyma and diffuse lymphocytic cell infiltration. The pathological findings of the lesion with strong histological change were islands of epithelial cells (epimyoepithelial islands), but no neoplastic changes were found. It was reported recently that benign lymphoepithelial lesion (BLEL) can change to a neoplastic tumor. Therefore, it is necessary to follow BLEL patients for a long time.
