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Papers - Ogawa, Kaoru

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Thyroglobulin concentration measurement in fine-needle aspiration fluid from cystic cervical lymph node metastases of papillary thyroid carcinoma

Inagaki Yozo, Sakamoto Koji, Inoue Yasuhiro, Imanishi Yorihisa, Tomita Toshiki, Shinden Seiichi, Ozawa Hiroyuki, Fujii Ryoichi, Shigetomi Seiji, Watabe Takahisa, Yamada Hiroyuki, Ogawa Kaoru

Journal of Otolaryngology of Japan 114 ( 12 ) 912 - 916 2011.12

ISSN 0030-6622

Background: Combining ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and fine-needle aspiration cytology (FNAC) usually results in the best preoperative diagnosis of cervical masses, including neoplasms. This may not be tnie, however, especially in occult papillary thyroid carcinoma (PTC) associated with single cystic cervical lymph node metastasis. We assessed the role of thyroglobulin measurement in FNA fluid (FNATg) in differentially diagnosing cystic cervical mass lesions, including PTC cystic lymph node metastasis. Methods: We reviewed the records of 17 subjects with cervical cystic masses undergoing both FNATg measure ment and surgery. FNA was done under ultrasonographic guidance. We also measured FNATg concentrations from extrathyroid lesions, consisting of cystic cervical lymph node metastases and benign cystic lesions. Results: Pathological diagnosis involved 5 PTC lymph node metastases, 3 lateral cervical cysts, 7 thyroglossal duct cysts, and 2 squamous cell carcinoma (lung and oropharynx) lymph node metastases. FNATg of PTC lymph node metastasis was much higher than the reference range of blood serum thyroglobulin, although much lower for the lateral cervical cyst detection threshold. FNAC and FNATg measurement are thought to be mutually complementary in the differential-diagnosis of PTC cystic lymph node metastasis. Conclusion : High concentrations of FNATg in a cystic cervical mass is considered specific to PTC lymph node metastasis, indicating its usefulness in distinguish PTC cystic metastasis from other cystic lesions. Including FNATg measurement with FNAC may thus improve preoperative diagnosis accuracy without additionally stressing subjects with PTC cystic lymph node metastasis.

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Late-phase recovery in the cochlear lateral wall following severe degeneration by acute energy failure

Mizutari Kunio, Nakagawa Susumu, Mutai Hideki, Fujii Masato, Ogawa Kaoru, Matsunaga Tatsuo

Brain Research 1419 1 - 11 2011.10

ISSN 0006-8993

We previously reported a model of acute cochlear energy failure using a mitochondrial toxin, 3-nitropropionic acid (3-NP), to study mechanisms of inner ear disorders such as inner ear ischemia. In this model, the main cause of hearing loss is apoptosis of fibrocytes in the cochlear lateral wall. Here, we analyzed the time course of structural and hearing level changes in the cochlea from the acute phase to the chronic phase up to 2 months after surgery. Hearing levels as determined by auditory brainstem response (ABR) thresholds exceeded the maximum acoustic output (> 87 dBSPL) of the system at all frequencies 1 day after 3-NP treatment. Histology showed nearly complete loss of fibrocytes 2 weeks after 3-NP treatment. However, after 2 months, ABR showed significant recovery at low frequency (8 kHz) in four of five rats treated with 3-NP. ABR thresholds at 20 kHz occasionally showed some recovery. At 40 kHz, recovery of ABR thresholds was not observed. Histology of 3-NP-treated rats revealed partial recovery of the lateral wall and the regenerated fibrocytes in the spiral ligament expressed Na/K-ATPase in the cochlear basal turn 2 months after 3-NP treatment. These results indicate that ABR recovery is caused by regeneration of the cochlear lateral wall. Our findings demonstrate the recoverable capacity of the cochlear lateral wall that leads to functional recovery after severe damage.

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Effectiveness of home-based vestibular rehabilitation in chronic dizziness

Goto Fumiyuki, Tsutsumi Tomoko, Arai Motohiro, Ogawa Kaoru

Practica Oto-Rhino-Laryngologica 104 ( 10 ) 681 - 687 2011.10

ISSN 0032-6313

Therapeutic options for vertigo may be pharmacological or non pharmacological. Intractable dizziness may require conventional drug therapy or vestibular exercises. We set up a single-group outpatient vestibular exercise course and evaluated its benefit. Subjects numbered 18 having chronic vertigo whose etiology included unilateral canal paresis following vestibular neuritis. Time from disease onset to the introduction of vestibular exercise was from 6 to 70 months (average ±std: 22.1±21.1). Small-groups home-based vestibular exercise consisted of a 2-hour lecture and practice in which subjects were taught exercises to be done 4 times a day at home. Symptoms of vertigo were obtained using Japanese version of the dizziness handicap inventory (DHI) and static posturography at the initial visit and before, 2 months, and 4 months after rehabilitation. The DHI score at the initial visit was 38. 6 ±26. 0 compared to 12. 3 ±10. 2 4 months after rehabilitation. The static posturography area did not change before or after therapy. We recommend that future studies objectively assess how the DHI score could be improved.

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Application of autogenic training in patients with Ménière disease

Goto Fumiyuki, Nakai Kimiko, Ogawa Kaoru

European Archives of Oto-Rhino-Laryngology 268 ( 10 ) 1431 - 1435 2011.10

ISSN 0937-4477

Data are limited on the role of psychotherapy in the treatment of Ménière disease. We sought to document the effect of a psychotherapeutic technique known as autogenic training on clinical outcome in Ménière disease. Six patients with Ménière disease were studied. Retrospective chart review was conducted. All patients were refractory to conventional therapy and completed a course of autogenic training, which was offered as a complementary treatment. Autogenic training with initial psychological counseling was conducted by a clinical psychologist during 45-min sessions. Outcome measures assessed were the frequency of vertigo and functional levels 2 years after initiation of autogenic training. Functional levels were evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head Neck Surgery (AAO-HNS). As a personality measure, we used the Maudsley Personality Inventory (MPI), devised by Eysenck, which measures neuroticism (N), extraversion (E), and propensity to lie (L). Five of six patients showed improved functional level after three to eight sessions of psychotherapy; hearing level did not change. The score of the N scale of the MPI was closely related to the number of psychotherapy sessions. Prognosis was evaluated based on the AAO-HNS reporting guidelines, as follows: A = 3, B = 1, C = 1, F = 1. The value of N in MPI was closely related to the number of psychological counseling sessions (R = 0.97, P < 0.05). In conclusion, autogenic training may enhance the mental well-being of patients with Ménière disease and improve clinical outcome.

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Thirteen-month-old boy with malignant lymphoma having symptoms mimicking acute otitis media and mastoiditis with facial palsy

Kanzaki Sho, Saito Hideyuki, Mori Tetsuya, Shimasaki Noriko, Mukai Makio, Ogawa Kaoru

ORL 73 ( 5 ) 266 - 270 2011.09

ISSN 0301-1569

Non-Hodgkin diffuse large B-cell lymphomas of the mastoid that extend from the nasopharynx are extremely rare in children. Moreover, in lymphoproliferative diseases, the presence of otoneurological signs prior to systemic disease involvement is rare. Here, we present a rare case of non-Hodgkin B-cell lymphoma invading the middle ear and mastoid in a 1-year-old boy that mimicked acute mastoiditis with complete facial nerve palsy. As this case illustrates, physicians should consider a diagnosis of malignant lymphoma if a patient presents with otitis media and mastoiditis accompanied by facial palsy.

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The Japanese version of the dizziness handicap inventory as an index of treatment success

Goto Fumiyuki, Tsutsumi Tomoko, Ogawa Kaoru

Acta Oto-Laryngologica 131 ( 8 ) 817 - 825 2011.08

ISSN 0001-6489

Conclusion: The Japanese version of the Dizziness Handicap Inventory (DHI) is a reliable, comprehensively validated, and clinically useful tool to measure self-perceived handicap associated with dizziness. Objectives: The DHI is a useful instrument to document the consequences of vestibular and/or balance impairment. A Japanese version of this self-assessment inventory is needed to evaluate the handicapping effects imposed by vestibular system disease in Japanese patients. The purpose of this study was to determine the internal consistency of the reliability of the Japanese version of the DHI. Methods: We recruited 176 patients between January and September 2008 from the outpatients of the Department of Otolaryngology, Hino Municipal Hospital, Japan. The DHI was translated into Japanese, and the test was independently completed by each subject. We used principal component analysis to evaluate the different dimensions of the DHI. The internal consistency of the retained factors was investigated by estimating Cronbach's alpha coefficients and corrected item-total correlations. Results: Cronbach's coefficients for internal consistency were high for the total scale (0.93) and good for the subscales: functional subscale (0.87), physical subscale (0.82), and emotional subscale (0.85). The correlation matrix demonstrated that the variables were suited for factor analysis. The determinant was 1.26E ⁶, which is slightly under the recommended value. Bartlett's test was highly significant (p < 0.0001), and the KaiserMeyerOlkin measure of sampling adequacy was 0.91.

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Influence of depressive symptoms, state anxiety, and pure-tone thresholds on the tinnitus handicap inventory in Japan

Oishi Naoki, Shinden Seiichi, Kanzaki Sho, Saito Hideyuki, Inoue Yasuhiro, Ogawa Kaoru

International Journal of Audiology 50 ( 7 ) 491 - 495 2011.07

ISSN 1499-2027

Objective: To assess factors that contribute to Tinnitus Handicap Inventory (THI) scores in Japan. Design: Case series with chart review. Study sample: Two hundred and eighty-five tinnitus patients at tertiary referral center, who completed the Japanese version of the THI, the Self-rating Depression Scale (SDS), and the State Trait Anxiety Inventory (STAI). Results: In multiple regression analysis, the SDS score contributed the most to the THI score. The state section of the STAI score and pure tone average (PTA) at four high frequencies also contributed significantly, but to lesser degrees. The other following factors were not statistically significant: age, gender, time from the onset of tinnitus to the first clinical visit, PTA at three mid frequencies, and trait section of the STAI score. This model may account for approximately 45% of THI score variability. Conclusions: The THI scores may be influenced by depressive symptoms, state anxiety, and pure tone thresholds in Japan.

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Acoustic overstimulation-induced apoptosis in fibrocytes of the cochlear spiral limbus of mice

Cui Yong, Sun Guang Wei, Yamashita Daisuke, Kanzaki Sho, Matsunaga Tatsuo, Fujii Masato, Kaga Kimitaka, Ogawa Kaoru

European Archives of Oto-Rhino-Laryngology 268 ( 7 ) 973 - 978 2011.07

ISSN 0937-4477

Fibrocytes of the spiral limbus are thought to play a significant role in maintaining ion homeostasis in the cochlea. The present study measured physiological and morphological changes in spiral limbus of mice in response to noise exposure. 6-week-old male C3H/HeJJcl mice were exposed to octave-band noise (120 dB SPL) for 2 h and evaluated at a series of times thereafter, up to 8 weeks. Permanent hearing loss resulted in the mice, as assessed by auditory brainstem response (ABR) recordings. The fibrocytes loss was found in the spiral limbus of the apical turn, which has been proved to be induced by apoptosis. These results suggest that noise exposure might result in apoptosis of fibrocytes in spiral limbus, which suggest a mechanism for noise-induced hearing loss.

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Expression and function of Sox21 during mouse cochlea development

Hosoya Makoto, Fujioka Masato, Matsuda Satoru, Ohba Hiroyuki, Shibata Shinsuke, Nakagawa Fumiko, Watabe Takahisa, Wakabayashi Ken Ichiro, Saga Yumiko, Ogawa Kaoru, Okano Hirotaka James, Okano Hideyuki

Neurochemical Research 36 ( 7 ) 1261 - 1269 2011.07

ISSN 0364-3190

The development of the inner ear is an orchestrated process of morphogenesis with spatiotemporally controlled generations of individual cell types. Recent studies have revealed that the Sox gene family, a family of evolutionarily conserved HMG-type transcriptional factors, is differentially expressed in each cell type of the mammalian inner ear and plays critical roles in cell-fate determination during development. In this study, we examined the expression pattern of Sox21 in the developing and adult murine cochlea. Sox21 was expressed throughout the sensory epithelium in the early otocyst stage but became restricted to supporting cells during adulthood. Interestingly, the expression in adults was restricted to the inner phalangeal, inner border, and Deiters' cells: all of these cells are in direct contact with hair cells. Evaluations of the auditory brainstem-response revealed that Sox21^-/- mice suffered mild hearing impairments, with an increase in hair cells that miss their appropriate planar cell polarity. Taken together with the previously reported critical roles of SoxB1 families in the morphogenesis of inner ear sensory and neuronal cells, our results suggest that Sox21, a counteracting partner of the SoxB1 family, controls fine-tuned cell fate decisions. Also, the characteristic expression pattern may be useful for labelling a particular subset of supporting cells.

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Pure tone auditory thresholds can change according to duration of interrupted tones in patients with psychogenic hearing loss

Oishi Naoki, Inoue Yasuhiro, Hori Akemi, Yakushimaru Reiko, Kohno Naoyuki, Ogawa Kaoru

Acta Oto-Laryngologica 131 ( 6 ) 628 - 632 2011.06

ISSN 0001-6489

Conclusion: Pure tone auditory thresholds can change according to duration of interrupted tones in patients with mild to severe psychogenic hearing loss (PHL). Objectives: To examine how the duration of stimulus tones affects the hearing thresholds of patients with PHL. Methods: Twelve patients with PHL (21 ears) were enrolled in this study. We initially measured their hearing thresholds using interrupted tones with a duration of 2 s and equal length of on-time and off-time, 225 ± 35 ms, respectively. After a 10 min interval, we measured their hearing thresholds using the same interrupted tones conditions lasting 5 s. The average threshold gains (2 s thresholds minus 5 s thresholds) were compared to those of 15 control subjects with normal hearing (25 ears), 15 patients with cochlear hearing loss (23 ears), and 4 patients with retrocochlear lesions (4 ears). Patients with profound PHL (4 patients, 6 ears) were analyzed separately. Results: The average threshold gain of PHL patients (excluding profound PHL patients) at all frequencies was 18.3 dB, which was significantly larger than that of other groups: 0.3 dB (profound PHL patients), 3.8 dB (controls with normal hearing), 3.0 dB (patients with cochlear hearing loss), and 3.2 dB (patients with retrocochlear lesions).

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Repetitive transcranial magnetic stimulation (rTMS) for treatment of chronic tinnitus

Minami Shujiro B., Shinden Seiichi, Okamoto Yasuhide, Watada Yukiko, Watabe Takahisa, Oishi Naoki, Kanzaki Sho, Saito Hideyuki, Inoue Yasuhiro, Ogawa Kaoru

Auris Nasus Larynx 38 ( 3 ) 301 - 306 2011.06

ISSN 0385-8146

Objective: There is compelling evidence that tinnitus is associated with functional alterations in the central nervous system. Repetitive transcranial magnetic stimulation (rTMS) is a potent tool for modifying neural activity at the stimulated area and at a distance along the functional anatomical connections. Depending on the stimulation parameters, cortical networks can be functionally disturbed or modulated in their activities. Low-frequency rTMS has been shown to result in a decrease in cortical excitability. The technique can alleviate tinnitus by modulating the excitability of neurons in the auditory cortex. We aimed to investigate the effects of low-frequency rTMS in patients and determine the factors that predict a beneficial outcome with rTMS treatment. Methods: Sixteen patients (male 10, female 6) with chronic tinnitus underwent low-frequency (1. Hz) rTMS (intensity: 110% motor threshold; number of stimuli: 1200) to the left auditory cortex. The treatment outcome was assessed with a visual analog scale (VAS) of loudness, annoyance and duration, loudness balance test, and tinnitus handicap inventory (THI). Therapeutic success was studied according to the patients' clinical characteristics. Results: A significant reduction in the VAS (loudness and annoyance) occurred immediately after rTMS, with a gradual return to pretreatment levels after 7 days. The tinnitus patients with sudden deafness were significant resistant to rTMS treatment compared with those diagnosed with age-related hearing loss. Conclusion: These results support the potential of rTMS as a new therapeutic tool for the treatment of chronic tinnitus. Because this study was performed with a small sample size and showed high interindividual variability in treatment effects, further development of the technique is needed before it can be recommended for clinical applications.

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Quality of life of Japanese seasonal allergic rhinitis patients is related to timing of pollen dispersal - Multicenter analysis

Kanzaki Sho, Ogawa Hiroshi, Ikeda Michiko, Masuda Takamasa, Ogawa Kaoru

Acta Oto-Laryngologica 131 ( 3 ) 290 - 297 2011.03

ISSN 0001-6489

Conclusion: Both the symptoms score and quality of life (QOL) score increased in patients with seasonal allergic rhinitis as pollen dispersed, and nasal congestion, which had a strong effect on sleep, had the largest effect on the decrease in 'total QOL' in all the groups of patients. Objectives: To assess QOL scores in patients with Japanese cedar (JC) pollinosis in relationship to timing of pollen dispersal. Methods: A multicenter, inter-group, cross-sectional study was conducted in 905 adult symptomatic patients with JC pollinosis to investigate the Japanese Allergic Rhinitis Standard QOL Questionnaire (JRQLQ).. The subjects were divided into five groups based on the timing of their responses to the questionnaire. JRQLQ scores were analyzed and compared among the patient groups. Results: Both the symptoms score and JRQLQ score increased in patients as pollen dispersed. Among the symptoms of pollinosis, nasal congestion had the largest effect on the decrease in QOL, and had a strong effect on sleep, which may influence daytime activities and reduce QOL.

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Impaired vibration of auditory ossicles in osteopetrotic mice

Kanzaki Sho, Takada Yasunari, Niida Shumpei, Takeda Yoshihiro, Udagawa Nobuyuki, Ogawa Kaoru, Nango Nobuhito, Momose Atsushi, Matsuo Koichi

American Journal of Pathology 178 ( 3 ) 1270 - 1278 2011.03

ISSN 0002-9440

In the middle ear, a chain of three tiny bones (ie, malleus, incus, and stapes) vibrates to transmit sound from the tympanic membrane to the inner ear. Little is known about whether and how bone-resorbing osteoclasts play a role in the vibration of auditory ossicles. We analyzed hearing function and morphological features of auditory ossicles in osteopetrotic mice, which lack osteoclasts because of the deficiency of either cytokine RANKL or transcription factor c-Fos. The auditory brainstem response showed that mice of both genotypes experienced hearing loss, and laser Doppler vibrometry revealed that the malleus behind the tympanic membrane failed to vibrate. Histological analysis and X-ray tomographic microscopy using synchrotron radiation showed that auditory ossicles in osteopetrotic mice were thicker and more cartilaginous than those in control mice. Most interestingly, the malleal processus brevis touched the medial wall of the tympanic cavity in osteopetrotic mice, which was also the case for c-Src kinase-deficient mice (with normal numbers of nonresorbing osteoclasts). Osteopetrotic mice showed a smaller volume of the tympanic cavity but had larger auditory ossicles compared with controls. These data suggest that osteoclastic bone resorption is required for thinning of auditory ossicles and enlargement of the tympanic cavity so that auditory ossicles vibrate freely.

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Learning sinus anatomy using 3D paper models

Araki Yasutomo, Kunihiro Takanobu, Saito Hideyuki, Ogawa Kaoru, Uno Kousuke, Yoshida Satoko, Satou Yasuo

Practica Oto-Rhino-Laryngologica 104 ( 3 ) 229 - 234 2011.03

ISSN 0032-6313

With complex nasal sinus anatomy difficult to understand, we designed a three-dimensional (3D) cubic paper sinus model for ENT residents. Seven subjects then put the model together and took it apart. Their understanding of sinus anatomy was assessed in multiple-choice questionnaires before and after training. All subjects' scores improved through training (167%, p=0. 005)-particularly identification of anatomical parts in the axial plain schema (308%, p=0. 007). These results show that 3D anatomical understanding improved dramatically. Training with the 3D cubic paper model thus proved cost-effective for ENT residents.

Editorial

Ogawa Kaoru

Auris Nasus Larynx 38 ( 1 ) 1 2011.02

ISSN 0385-8146

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Clinical review and statistical analysis of tongue squamous cell carcinoma

Sakamoto Koji, Imanishi Yorihisa, Tomita Toshiki, Ozawa Hiroyuki, Tagawa Takamasa, Fujii Ryoichi, Shigetomi Seiji, Habu Noboru, Ootsuka Kuninori, Yamashita Taku, Kanke Minoru, Fujii Masato, Ogawa Kaoru

Japanese Journal of Head and Neck Cancer 37 ( 4 ) 529 - 535 2011

ISSN 1349-5747

We reviewed 86 patients with oral tongue squamous cell carcinoma who were initially treated with curative intent in the Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine between 1996 and 2007. Statistical analysis was performed to examine the prognostic value of the clinical features. Eighty patients underwent surgery and six underwent radiotherapy as the initial treatment. The five-year disease-free survival (DFS) rates determined by the Kaplan-Meier method were as follows: 75.8% in all stages, 88.7% in stage I (n = 30), 82.6% in stage II (n = 24), 77.1% in stage III (n = 14), and 39.7% in stage IV (n = 18). Univariate analysis demonstrated that stage III/IV, T 3/4, and N2 were significantly correlated with poor prognosis, whereas multivariate analysis showed that only N2 was independently correlated with poor prognosis. Neoadjuvant chemotherapy (NAC) was applied for 24 patients. Although the DFS of the responders (CR+PR) was higher than that of the non-responders (NC+PD), the difference was not significant. Among 80 patients who received surgical treatment initially, neck dissection (ND) was performed in 42 patients. Five-year DFS was significantly higher in the patients with no or single node metastasis than in the patients with multiple node metastases (93.8% vs. 32.7%). These outcomes suggest that more aggressive postoperative therapy should be recommended for patients found to have pathologically multiple positive nodes.

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Unusual computed tomography findings of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer

Baba Yuh, Kato Yasumasa, Ogawa Kaoru

Journal of Medical Case Reports 5 2011

ISSN 1752-1947

Abstract. Introduction. Radionecrosis (post-radiotherapy laryngeal submucosal inflammation and necrosis) is a complication of (chemo) radiotherapy for hypopharyngeal cancer that is difficult to differentiate from tumor recurrence. Case presentation. A 67-year-old Japanese man presented with a condition extremely difficult to diagnose differentially as radionecrosis or tumor recurrence after radiotherapy for hypopharyngeal cancer. Although tumor recurrence was suspected from clinical conditions and computed tomography findings, pathologic analysis revealed no evidence of tumor recurrence, and successful therapy with steroids and antibiotics reduced the mucosal edema. Conclusion: Our findings emphasize the wide spectrum of radiographic presentation of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer.

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Investigation of the reliability and validity of the vertigo handicap questionnaire (VHQ) translated into Japanese

Goto Fumiyuki, Arai Motohiro, Tsutumi Tomoko, Masuda Kanako, Ogawa Kaoru

Equilibrium Research 69 ( 6 ) 412 - 417 2010.12

ISSN 0385-5716

We have translated the dizziness handicap questionnaires (DHI), which were one of the dizziness questionnaires of a few years ago, confirmed the reliability and applied our results in our clinical research. However each of the sentences in the DHI is not always familiar to the individual dizzy patient. Some other type of questionnaires would therefore be better for some dizzy patients. A vertigo handicap questionnaire (VHQ) is one of the questionnaires for the quantitative evaluation of the degrees of handicap in the daily lives of patients with vestibular disorders. It consists of 25 questions. The aim of the present study was to examine the validity and reliability of the Japanese translation of the VHQ (VHQ-J). The VHQ-J was undergone by 110 patients suffering dizziness. The results were analyzed and are summarized as follows: (1) Cronbach's alpha coefficient, which measures the reliability based on the consistency of the questionnaire, was 0.78. (2) The VHQ-J components significantly correlated with the Dizziness handicap inventory (DHI-J) (p<0.05). (3) The VHQ-J results significantly correlated with the Hospital Anxiety and Depression Scale (HADS) (p<0.05). (4) The VHQ-J significantly correlated with the State-Trait Anxiety Inventory (STAI) (p<0.05). These results indicated that the VHQ- J is a valid and reliable questionnaire that can be used to assess the degree of handicap in the daily lives of patients with vestibular disorders.

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Sho-saiko-to-ka-kikyo-sekko as an alternative treatment for chronic tonsillitis to avoid surgery

Goto Fumiyki, Asama Youji, Ogawa Kaoru

Complementary Therapies in Clinical Practice 16 ( 4 ) 216 - 218 2010.11

ISSN 1744-3881

Sho-saiko-to-ka-kikyo-sekko (TJ-109) is composed of 9 herbs (gypsum, Bupleurum root, Pinellia tuber, Scutellaria root, Platycodon root, jujube fruit, ginseng root, Glycyrrhiza root, and ginger rhizome). It is a folk medicine that has been used to treat pharyngitis or acute tonsillitis. The efficacy of TJ-109 for treating patients with chronic tonsillitis was investigated. Ten outpatients who experienced chronic tonsillitis for more than 2 years were recruited. TJ-109 was prescribed, and after one year of daily treatment the incidence of acute tonsillitis before and after the treatment was compared. The incidence of acute tonsillitis due to chronic tonsillitis decreased in all 7 patients who were followed up. No adverse events were observed in any of the patients. In conclusion, the herbal medicine TJ-109 effectively reduced the incidence of acute tonsillitis. In some cases, planned tonsillectomy was avoided.

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Surgical outcome in headache due to mucosal contact

Goto Fumiyuki, Yabe Haruna, Ogawa Kaoru

Practica Oto-Rhino-Laryngologica 103 ( 10 ) 915 - 920 2010.10

ISSN 0032-6313

Headaches is classified as primary and secondary, with secondary originating in head and neck conditions, the most important etiology being acute sinusitis. Headache due to mucosal contact, rarely encountered by otorhinolaryngologists, is an important secondary headache, whose criteria are defined by the International Classification of Headache Disorders to include intermittent pain localized in the periorbital and medial canthal or temporozygomatic regions, evidence that pain is attributable to mucosal contact and the presence of mucosal contact in the absence of acute rhinosinusitis, obtained using clinical examinations, nasal endoscopy, and/or computed tomography (CT). After mucosal contact is surgically corrected pain usually disappears permanently within 7 days. We reviewed mucosal contact headaches in 63 subjects undergoing nasal or paranasal surgery from April 2007 to March 2008. Of those 7 were diagnosed with headaches due to contact points in nasal mucosa, ranging from canthal to the temporozygomatic. The most common contact, between the middle turbinate and nasal septum, was seen in 6 of the 7. Surgery eliminated symptoms in 4 and ameliorated them in 3 indicating effective headache management. Subjects with severe headaches or localized periorbital and medial canthal pain regions, mucosal contact involvement is ruled out when CT allows no lesions. When mucosal contact headache is suspected, however surgery should be considered as a last resort.

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