Conclusion: The comprehensive Hearing Preservation classification system presented in this paper is suitable for use for all cochlear implant users with measurable pre-operative residual hearing. If adopted as a universal reporting standard, as it was designed to be, it should prove highly beneficial by enabling future studies to quickly and easily compare the results of previous studies and meta-analyze their data. Objectives: To develop a comprehensive Hearing Preservation classification system suitable for use for all cochlear implant users with measurable pre-operative residual hearing. Methods: The HEARRING group discussed and reviewed a number of different propositions of a HP classification systems and reviewed critical appraisals to develop a qualitative system in accordance with the prerequisites. Results: The Hearing Preservation Classification System proposed herein fulfills the following necessary criteria: 1) classification is independent from users' initial hearing, 2) it is appropriate for all cochlear implant users with measurable pre-operative residual hearing, 3) it covers the whole range of pure tone average from 0 to 120 dB; 4) it is easy to use and easy to understand.
Abstract Conclusion: It is important to suppress lymph node recurrence and distant metastasis to achieve better survival of advanced laryngeal cancer, especially supraglottic cancer. Objective: The therapeutic outcomes of 33 cases with advanced laryngeal cancer treated at Kyoto University Hospital between 2000 and 2008 were reviewed. Methods: Thirty-one males and two females were involved. Their ages ranged from 49 to 81 years (average 65.6 years). All tumors were squamous cell carcinoma, arising at the glottis in 21 cases and the supraglottis in 12 cases. Most glottic cancers (90.5%) and supraglottic cancers (83.3%) were classified as T3 or T4. Total laryngectomy with neck dissection was performed in the treatment of T3 or T4 cases. Two cases of T2 cancers were treated by radiotherapy (66–72 Gy) with neck dissection, and one case of T2 cancer was treated by radiotherapy (66 Gy). Partial laryngectomy with neck dissection was performed in one T3 case. Results: Five-year overall survival rates for stage III of glottic cancer, stage IV of glottic cancer, stage III of supraglottic cancer, and stage IV of supraglottic cancer were 100%, 40.9%, 100%, and 24.2%, respectively. Five-year disease-specific survival rates for stage III of glottic cancer, stage IV of glottic cancer, stage III of supraglottic cancer, and stage IV of supraglottic cancer were 100%, 56.3%, 100%, and 28.1%, respectively. No local recurrence occurred. Regional lymph node recurrence occurred in two cases– one patient with glottic cancer and one with supraglottic cancer. Both of them died of disease despite undergoing chemotherapy. One case initially had lung metastasis, and post-treatment distant metastasis occurred in the lung in four cases, in the skin in one, and in multiple organs in one case.
CONCLUSION:Three types of inner ear drug delivery systems (DDS) that were ready to be applied in clinics were developed.OBJECTIVES:To develop clinically applicable inner ear DDS for the treatment of inner ear disorders.METHODS:Inner ear DDS using clinically applicable materials were developed and evaluated.RESULTS:The systemic application of stealth-type nanoparticles encapsulating betamethasone provided superior therapeutic results for the treatment of noise-induced hearing loss compared with the systemic application of betamethasone in mice. Microparticles made of biodegradable polymer (poly (lactic/glycolic) acid, PLGA) encapsulating lidocaine were placed on the round window membrane of guinea pigs, and resulted in reasonable concentrations of lidocaine in the cochlea without serious adverse effects. The phase I/IIa clinical trial of the application of insulin-like growth factor-1 (IGF-1) in combination with gelatin hydrogel on the round window membrane was conducted, recruiting patients with acute sensorineural hearing loss after the failure of systemic application of steroids.
Conclusion: In cases of labyrinthine fistulae, we performed complete removal of the cholesteatoma matrix in a one-stage procedure, resulting in a satisfactory bone conduction (BC) hearing preservation rate. Preoperative evaluation of labyrinthine fistulae using high resolution computed tomography (HRCT) detected 86% of cases, and this contributed to favorable results achieved with the surgical treatment of labyrinthine fistulae. We aimed to review cases of labyrinthine fistulae to summarize their outcomes and establish standards of management. Methods: This was a retrospective chart review of 22 patients with labyrinthine fistulae at Kyoto University Hospital from 2001 to 2009. Patient background (age and sex), location and stage of the fistulae, facial nerve status, preoperative and postoperative BC hearing levels, preoperative CT diagnosis, and surgical procedures were analyzed. Results: The incidence rate of the labyrinthine fistulae was 11.2%. All but one patient had labyrinthine fistula due to cholesteatoma. The fistulae were found in the lateral semicircular canal in 17 cases (77%) and in multiple organs in 4 cases (18%). The BC hearing level was preoperatively scaled out in seven cases. Preoperative HRCT scan revealed the presence of fistulae in 19 cases (86%). For all cases of cholesteatoma, the matrix was completely removed in a one-stage procedure and the fistulae were sealed using bone pate, temporal fascia, and temporal bones. Of the 15 cases with residual BC hearing ability, BC hearing was preserved in up to 12 cases. Two cases with postoperative deterioration of BC hearing had stage 4 fistulae in the cochleae.
Conclusions It is suggested that radiotherapy might be the first choice for stage I/II hypopharyngeal cancer, and that adjuvant treatment might be necessary for stage II patients to prevent distant metastasis Objectives To update the therapeutic outcome of early hypopharyngeal cancer Methods Twenty-eight patients with stage hypopharyngeal cancer (8 in stage I, 20 in stage II) were treated at Kyoto University Hospital between 1995 and 2007 Of 8 cases in stage I, radiotherapy was applied for 4 cases, and surgical treatment for another 4, while 13 of 20 cases in stage II underwent radiotherapy and the remaining 7 cases underwent surgery Results The 5-year cumulative disease-specific survival and larynx preservation rates were 74 6% and 73 2%, respectively Recurrent tumors were found in two cases in stage I treated by surgery and in five cases in stage II treated with radiotherapy Two of five recurrent cases in stage II were rescued by salvage surgery Distant metastasis to the lung appeared in two cases in stage II after initial treatment
Conclusions: Medialization thyroplasty was effective in improving swallowing function as well as vocal function in most cases with unilateral vocal fold paralysis. The impact of medialization thryoplasty was insufficient for the case with severe atrophy and that in which the vocal fold was fixed in the lateral position. Objectives: To evaluate the impacts and limitations of medialization thyroplasty on swallowing function of the patients with unilateral vocal fold paralysis. Methods: Eight cases (mean age 68.5 years) with unilateral vocal fold paralysis chiefly complaining of swallowing disturbance were studied. All patients underwent thyroplasty type I. The causes of the paralysis were lung cancer in four cases, esophageal cancer in one case, aortic aneurysm in one case, subarachnoid hemorrhage in one case, and unknown in one case. Subjective swallowing function score, maximum phonation time (MPT), mean flow rate (MFR), amplitude perturbation quotient (APQ), and pitch perturbation quotient (PPQ) were examined pre- and postoperatively. Results: The swallowing score improved in all except two cases. However, bilateral thryoplasty was necessary for the case with severe vocal fold atrophy and arytenoid adduction was needed for the case in which the vocal fold was fixed in the lateral position. The swallowing score, MPT, and MFR showed significant improvement after surgery.
Conclusions Contralateral hearing loss is significantly correlated with poor hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) Background The hearing outcome in patients with ISSNHL was analyzed using multiple variables Methods A retrospective chart review was conducted using 89 patients with ISSNHL Patients within 40 dB HL of average hearing levels and/or patients whose hearing loss was restricted to low frequencies were excluded The influence of preexisting conditions on hearing outcome was analyzed using a polytomous universal model Pre-existing conditions analyzed included hyperglycemia, hypercholesterolemia, hypertension, and contralateral hearing loss In addition, the severity of hearing loss, age group, and the existence of vertigo were analyzed concomitantly Results Hearing recovery was significantly reduced in patients with a past history of contralateral hearing loss
Conclusions The prognosis of patients was related to the initial stage at diagnosis These results suggest that early diagnosis and treatment are the most important factors to improve the prognosis in oral cancer patients Adjuvant treatment is also warranted to improve locoregional control of advanced cases Objectives To update the therapeutic outcome of oral cancer Methods In all, 129 cases with oral cancer were treated at Kyoto University Hospital during 2000-2008 Surgery with/without irradiation was performed for 34 cases in stage I, 27 in stage II, 15 in stage III, 42 in stage IVa, and 1 case in stage IVb Brachytherapy was performed for three cases in stage II Definitive radiotherapy was performed for three cases in stage III and five cases in stage IV The follow-up period varied from 12 to 96 months (mean 30 months) Results The 5-year cumulative overall and disease-specific survival (DSS) rates were 74 5% and 75 3% DSS was 86 2% in stage I, 91 6% in stage II, 70 7% in stage III, 60 2% in stage IVa, and 0% in stage IVb DSS shows worse prognosis with advanced nodal status Locoregional recurrence occurred in 32 of 129 cases, including local recurrence in 8 cases, nodal recurrence in 18, retropharyngeal node metastasis in 1, and local and nodal recurrence in 5 cases Salvage operation with/without postoperative radiotherapy was performed for 22 cases with locoregional recurrence and 7 of them have survived
CONCLUSION:The epidemiology of vertigo remains unclear. This study might contribute to an understanding of the mechanisms underlying vestibular disease.OBJECTIVE:To investigate the epidemiological features of patients with vertigo.METHODS:A retrospective study on 612 patients with vertigo who visited Kyoto University Hospital.RESULTS:Elderly individuals comprised > 30% of patients presenting with vertigo, with more female patients than male patients.
CONCLUSION:Organ preservation surgery with partial pharyngectomy preserving the larynx is feasible for the treatment of advanced hypopharyngeal cancer with comparable local control and preservation of function.OBJECTIVES:To examine the feasibility and therapeutic effects of organ preservation surgery for advanced hypopharyngeal cancer.METHODS:Fourteen patients with stage III/IV hypopharyngeal cancer were treated by partial pharyngectomy with or without partial laryngectomy to preserve the larynx. Ten cases were T1/2 primary while four cases had T3/4 tumors. Reconstruction of the pharyngolarynx was completed by primary mucosal suture in six, while free forearm flap was used in eight cases. Induction chemotherapy was administered for six cases including three with T3/4 tumors.RESULTS:Five-year overall survival and disease-specific survival rates were 57.1% and 66.7%, respectively. The 5-year locoregional control rate was 66.7% and the larynx preservation rate was 100%. No patients presented with local recurrence at the pharyngolaryngeal segment, while two cases showed nodal recurrence, from which they died. Tracheal stoma was closed in 9 of 14 cases. Vocal function was excellent in five cases, moderate in five, and poor in three. Swallowing function was excellent to moderate in eight cases and poor in six.
Conclusion The present findings indicate that conventional nasal packing is not required for endoscopic endonasal surgery Objectives To evaluate the routine use of packing in endoscopic endonasal surgery Methods From January 2006 through January 2009, 146 consecutive patients who underwent endoscopic endonasal surgery performed by the same surgeon in Kyoto University Hospital were evaluated The surgical procedure was ended with conventional gauze packing m 70 consecutive patients from January 2006 through August 2007 (Packing group), and placing of oxidized cellulose on operative sites was performed in 76 consecutive patients from September 2007 to January 2009 (Non-packing group) We analyzed demographic characteristics, comorbidities, surgical procedures, incidence of packing the nose after excessive postoperative bleeding, and occurrence of postoperative adhesion Results No significant differences in the demographic characteristics, except for gender, and in comorbidities were found between the two groups The number of endoscopic sinus surgery procedures with septoplasty and/or turbinoplasty, or tumor extirpation in the Non-packing group was significantly larger than that in the Packing group There was no significant difference in the incidence of postoperative bleeding or postoperative adhesion between the two groups
CONCLUSION:The average age at the time of cochlear implantation is progressively being reduced. While cochlear obstruction and perilymph/cerebello-spinal fluid gusher were found in some cases, preoperative MRI and CT scans were predictive of such occurrences. The preoperative developmental quotient in the Cognitive-Adaptive Area was strongly correlated to the postoperative development in the Language-Social Area.OBJECTIVE:To summarize the background, implant devices, intraoperative findings, and postoperative developmental quotients of prelingually deafened patients who underwent cochlear implantation.METHODS:We conducted a retrospective chart review of 134 prelingually deafened cochlear implant recipients.RESULTS:The median age at implantation was 3 years and 5 months. Most patients were born deaf without any known etiologies. In most cases, the transmastoid facial recess approach was utilized. Cochlear obstruction was identified in four patients, all of whom lost their hearing as a result of meningitis. Perilymph/cerebello-spinal fluid gusher was observed in six patients with inner ear anomalies. The preoperative developmental quotient for the Cognitive-Adaptive Area showed significant correlation with the postoperative developmental quotient in the Language-Social Area with a correlation coefficient of 0.71.
CONCLUSION:Hydrogen gas effectively protected against the morphological and functional vestibular hair cell damage by reactive oxygen species (ROS).OBJECTIVE:ROS are generally produced by oxidative stress. In the inner ear, ROS levels increase as a result of noise trauma and ototoxic drugs and induce damage. It is thus important to control ROS levels in the inner ear. The protective effects of hydrogen gas in cochlear hair cells have been reported previously.METHODS:This study examined the effects of hydrogen gas on mouse vestibular hair cell damage by ROS using antimycin A.RESULTS:In the group *exposed to hydrogen gas, vestibular hair cells were morphologically well preserved and their mechano-electrical transduction activities were relatively well maintained when compared with controls. Hydroxyphenyl fluorescein (HPF) fluorescence in vestibular tissue was also reduced by hydrogen gas.
Conclusions: Most ears that were treated with a new surgical method were rendered dry and safe, with cavity problems minimized by this simple technique. This technique is also valid in terms of medical economy because it shortens the hospitalization period and subsequent outpatient care is not required frequently. Objectives: Canal wall-down tympanomastoidectomy was a well established procedure for severe chronic otitis media, especially cholesteatoma. However, this procedure has some defects, so-called cavity problems, caused by non-epithelialized bony wall. The aim of this study was to evaluate the early epithelialized technique for the surface of widely formed external acoustic meatus after canal wall-down tympanomastoidectomy. Methods: Twenty-five patients who had been diagnosed with cholesteatoma were divided into two groups. Group I consisted of 15 patients who underwent a new method in which the open cavity was lined with a pedicle periosteal flap of the postauricular region together with free temporal fascia grafts. As a control, 10 patients in group II underwent the standard operation that uses only free temporal fascia grafts. Results: A comparison of the two groups showed that it took only 1 month on average for the entire surface of the external auditory meatus of the patients in group I to epithelialize and dry up perfectly, although the same area in all the patients in group II was not dried up perfectly until over 80 days.
Conclusion This new regenerative therapy shows great potential for the treatment of stenosis of the trachea and/or cricoids (STC) Objectives To estimate the potential of tissue-engineered artificial trachea (AT) for treatment of STC in clinical applications We previously reported that AT was a useful material for implantation into a tracheal defect after resection of cancer There are many causes of stenosis of the respiratory tract and STC is particularly difficult to treat Methods The AT was a spiral stent composed of Marlex mesh made of polypropylene and covered with collagen sponge made from porcine skin Three patients with STC were treated by this tissue-engineering method All of them suffered from STC caused by long endotracheal intubations They underwent a two-stage operation In the first operation, after resection of the stenotic regions, the edge of the tracheal cartilage was sutured to the edge of the skin The tracheal lumen was exposed and a T-shaped cannula was inserted into the large tracheostoma At 3 weeks to 2 months after the first operation, the trachea and skin were separated The trimmed AT with venous blood and basic fibroblast growth factor (b-FGF) was then implanted into the cartilage defect Results Postoperatively, all patients were able to breathe easily and had no discomfort in their daily activities Six months after the second operation, we observed enough air space in the trachea and cricoid by computed tomography (CT) imaging and fiber endoscopy
Conclusion We performed ossiculoplasty under conditions preventing inflammation by adopting a planned staged operation, which is suitable for ossiculoplasty using an artificial prosthesis We identified the presence of chorda tympani nerve as a candidate predictive factor for successful ossiculoplasty Objectives We aimed to summarize the outcome of ossiculoplasty and to find factors to improve the success rate Methods This was a retrospective chart review of 96 patients who underwent ossiculoplasty in Kyoto University Hospital from 2001 to 2008 Patients' backgrounds, hearing outcomes, and surgical procedures were analyzed To find predictive factors for successful ossiculoplasty, we performed logistic regression analysis Results The improvement in the mean air conduction level was 12 9 dB The mean postoperative air bone gap (ABG) was 25 0 dB The ABG decreased to within 20 dB in 40 7% of the cases As a result of univariate logistic regression analysis, primary or planned second stage surgery, closed mastoid cavity, and presence of the chorda tympani nerve were identified as favorable factors for successful ossiculoplasty
Conclusion The number of studies on inpatients with vertigo is limited This study provides useful information for clarifying the underlying causes of vertigo Objective To investigate the epidemiological features of patients with vertigo Methods This retrospective study investigated 78 patients who had been emergently hospitalized in the Otolaryngology Department of Kyoto University Hospital with vertigo Results The number of female patients was significantly higher than the number of male patients Meniere's disease was the most common underlying pathology among hospitalized patients Mean patient age was 56 1 years, with no significant difference between male and female patients
Abstract Conclusions: Once-daily radiotherapy for stage I glottic cancer and hyperfractionated radiotherapy for stage II glottic cancer achieved satisfactory results in terms of prognosis and laryngeal preservation. The treatment strategy for stage II glottal cancer with subglottal invasion needs to be reconsidered to further improve the outcome. Objectives: Although early glottic carcinomas are highly curable by radiation therapy, the laryngeal preservation rate is not always sufficient. We reviewed the stage I/II glottal cancer treated in our institute during a recent 15-year period to improve the outcome and prognosis. Methods: In all, 113 cases of stage I/II glottic cancer (81 stage I cases and 32 stage II cases) were treated in Kyoto University hospital from 1994 to 2008. In 81 cases with stage I glottic cancer, radiation was performed for 66 cases, transoral laser excision (TLE) was performed for 14 cases, and hyperfractionated radiotherapy was done for one case. Among 32 cases with stage II glottic cancer, 24 cases were treated with hyperfractionated radiotherapy, 6 cases were treated with radiation, and one case with partial laryngectomy. Total laryngectomy was performed for one patient who suffered mixed connective tissue disease. Kaplan–Meier estimates were used for the analysis of survival rate and laryngeal preservation rate. Results: The 5-year overall survival rates were 88.4% in stage I cases and 89.1% in stage II cases. The 5-year disease-specific survival rates were 100% in stage I cases and 93% in stage II cases. The 5-year laryngeal preservation rates were 99% in stage I cases and 90% in stage II cases. Two cases of stage II glottal cancer with subglottal invasion failed to be controlled and the patients died from local recurrence and mediastinum lymph node metastasis, respectively.
CONCLUSION:Bone marrow-derived cells (BMDCs) are constitutively present in the vestibular end organs and in the endolymphatic sac, and may play a role in the maintenance of inner ear homeostasis.OBJECTIVES:The aim was to examine the distribution and characteristics of BMDCs in the vestibular end organs and in the endolymphatic sac.METHODS:Bone marrow-chimeric mice were generated by bone marrow transplantation from mice genetically labeled with enhanced green fluorescent protein to C57 Bl/6 mice to visualize BMDCs. Three months after bone marrow transplantation, inner ear specimens were processed for histochemical analyses.RESULTS:BMDCs were widely distributed in the vestibular end organs and the endolymphatic sac, whereas there were differences in the phenotype and the distribution between the vestibular end organs and the endolymphatic sac. A subpopulation of BMDCs in the vestibular end organs expressed antigen-presenting protein MHC class II. Moreover, the density of BMDCs in the vestibular end organs increased in response to local mechanical stress.
CONCLUSION:The significant up-regulation of matrix metalloproteinase (MMP)-9 mRNA, which is not modulated by tissue inhibitor of metalloproteinase (TIMP)-1, is an additional source of increased proteolytic activity in virus-infected upper airways that might contribute to the exacerbation of chronic rhinosinusitis with nasal polyps.OBJECTIVES:Chronic rhinosinusitis is often exacerbated by viral infection. We hypothesized that a disruption of the mechanisms that regulate the activity of MMPs during viral infection is one possible mechanism responsible for the exacerbation. In the present study we attempted to achieve a better understanding of MMP expression in nasal epithelial cells after viral infection.MATERIALS AND METHODS:Human nasal epithelial cells were isolated from nasal polyp specimens obtained during endoscopic endonasal surgery in chronic rhinosinusitis patients. We investigated the expression of MMP-2, MMP-9, and TIMP-1 mRNA in primary human nasal polyp epithelial cells after dsRNA stimulation.RESULTS:Among the genes whose expression was evaluated, only expression of MMP-9 mRNA increased significantly after dsRNA stimulation.
