Details of a Researcher - Ozawa, Hiroyuki

Papers - Ozawa, Hiroyuki

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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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The outpatient palliative care conference for the home palliative care shift (the second report)--the conference was used to look back on the case where the patient's QOL was kept and improved

Asaba Kaori, Chigira Mayumi, Hashimoto Eiko, Hano Ayumi, Sofue Akira, Umeki Mikiko, Murotsu Keizo, Ozawa Hiroyuki, Shiraishi K.

Gan to kagaku ryoho. Cancer & chemotherapy 36 Suppl 1 84 - 88 2009.12

ISSN 0385-0684

The patient was a 30-year-old woman with right tongue cancer and SCC (T4N2bM0). After it had relapsed, the outpatient palliative care conference intervened. The purpose of intervention was as follows: pain control, nutrition management, home recuperation support, and relief of a spiritual pain. We could achieve the patient's desire to recuperate at home as long as possible by sharing a goal and information. The patient was treated for a total of 457 days. Since the relapse, she was treated for 274 days, and was hospitalized for 49 days. By offering necessary home care supports, the patient and family fully demonstrated their potentials what they could do to recuperate and resulted in a long home stay. It was thought that our relationship with the patient and family appeared to have enhanced their self-resistance feelings against the disease. Consequently, we contributed the improvement of QOL.

Promoted cell proliferation by connexin 30 gene transfection to head-and-neck cancer cell line

Ozawa Hiroyuki, Mutai Hideki, Matsunaga Tatsuo, Tokumaru Yutaka, Fujii Masato, Sakamoto Kouji, Tomita Toshiki, Ogawa Kaoru

Anticancer Research 29 ( 6 ) 1981 - 1985 2009.06

ISSN 0250-7005

Background: There have been inconsistent results regarding the contribution of the connexin family of genes to tumor cell proliferation. Materials and Methods: We aimed to clarify the role of connexin 30 (Cx30), by transfecting three kinds of vectors that express either full length Cx30 (Cx30-Full), Cx30 devoid of C-terminal region (Cx30-DelC) or Cx30 C-terminal region (Cx30-CT), in HSC-4, a head-and-neck cancer cell line. Results: Transfected Cx30-Full was localized on the plasma membrane, while Cx30-DelC and Cx30-CT was expressed in the cytoplasm or circumnuclear sites. We studied the effect on the growth rate followed by immunostaining with anti-Ki-67 (MIB-1). The MIB indices of HSC-4 cells transfected with Cx30-Full and Cx30-DelC, but not Cx30-CT were shown to be significantly higher than that of the controls. Conclusion: Our results demonstrated that Cx30 enhanced the proliferation of HSC-4 cells and the proliferating activity was considered to be achieved without the transport of the protein onto the plasma membrane.

Diagnosis and management of cervical sympathetic chain schwannoma

Tomita Toshiki, Ozawa Hiroyuki, Sakamoto Koji, Ogawa Kaoru, Kameyama Kaori, Fujii Masato

Acta Oto-Laryngologica 129 ( 3 ) 324 - 329 2009.03

ISSN 0001-6489

Conclusions. Cervical sympathetic chain schwannoma (CSCS) sometimes mimics carotid body tumor (CBT). Differential diagnosis between these tumors is sometimes difficult using MRI alone. MRA, color Doppler ultrasonography, and fine needle aspiration (FNA) after imaging may be helpful to rule out CBT. Surgical resection of CSCS is relatively effortless, and Horner's syndrome is an expected but acceptable postoperative complication. Intratumoral hemorrhage and vasodilation may be the main reasons for significant enhancement on MRI. Objectives. CSCSs are rare and known to mimic carotid body tumors. We report 9 cases of CSCS with an emphasis on imaging, surgical management, and pathological findings. Moreover, we describe the differential diagnosis of CSCS and CBT, and speculate the reasons behind significant enhancement on MRI. Patients and methods. Nine cases of CSCS treated at a tertiary referral center between 1996 and 2008 were reviewed. Results. MRI revealed 3 of 9 cases (33%) splayed the carotid bifurcation and displayed marked contrast enhancement with gadolinium. All patients underwent surgical excision of the mass with minimal blood loss. Postoperative Horner's syndrome was encountered in all patients, which required no treatment. Marked gadolinium enhancement tended to be associated with histological findings such as intratumoral hemorrhage and vasodilation. © 2009 Informa UK Ltd. (Informa Healthcare, Taylor & Francis As).

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Mucoepidermoid carcinoma of the head and neck

Ozawa Hiroyuki, Tomita Toshiki, Sakamoto Koji, Tagawa Takamasa, Fujii Ryoichi, Kanzaki Sho, Ogawa Kaoru, Kameyama Kaori, Fujii Masato

Japanese Journal of Clinical Oncology 38 ( 6 ) 414 - 418 2008.06

ISSN 0368-2811

Objective: It is well known that mucoepidermoid carcinoma (MEC) displays a variety of biological behaviors. While the high-grade type is a highly aggressive tumor, its low-grade counterpart usually demonstrates a more benign nature and several systems have, therefore, been proposed to grade this neoplasm. Methods: This report analyzes 43 patients suffering from head and neck MEC, who were treated in our department during the period from 1989 to 2005. The relationship between clinical and pathologic characteristics and survival rate was investigated. Results: The 5-year overall and disease-free survival rate was 62.3 and 57.2%. Multivariate analysis demonstrated that the parameters that significantly affected survival were the patient's age (P = 0.040) and treatment method (P = 0.011). Conclusions: The patient's age and treatment method is the prognostic parameter in this study. Although complete surgical resection is the standard treatment for MEC, we should aggressively consider adjunctive radiotherapy in those cases that have a high risk of recurrence and poor prognosis. © The Author 2008. Published by Oxford University Press. All rights reserved.

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A multidisciplinary approach to carotid body tumors. Report of five cases

Tomita Toshiki, Ozawa Hiroyuki, Tagawa Takamasa, Sakamoto Koji, Ogawa Kaoru

Journal of Otolaryngology of Japan 110 ( 12 ) 743 - 751 2007.12

ISSN 0030-6622

We performed a retrospective review of five patients with carotid body tumors at our institution between 1997 and 2005. Out of the five patients, three patients were treated by surgical resection of the tumor, and 2 patients were observed. It would seem that it is difficult to suspect this disease based only on the clinical findings, because the disease was suspected in only one patient at the first medical examination. Imaging tests are important for establishment of the diagnosis. Color Doppler sonography and MR angiography in addition to MRI are useful. Angiography and balloon Matas test are important for selection of candidates for the operation. The resected tumors were all classified in Shamblin's group II. Delayed cerebral infarction was caused in one patient postoperatively, although the carotid artery was preserved. The dissection in a tumor-adventitial plane using the bipolar coagulation technique under the microscope was performed in the other two cases. Histological examination of the specimen revealed no tumor cells in the excision stump. Dissection in the tumor-adventitial plane using bipolar coagulation under the microscope is important for carotid artery preservation and radical resection of Shamblin's group I and II tumors. It is necessary to compare the risk of the operation with the problems of observation in the process of decision making and to achieve reliable informed consent. Moreover, it is necessary to examine the indications for operation in individual cases referring to the age, past history, expected Shamblin's classification, and result of the balloon Matas test. A multidisciplinary approach should be used, involving the fields of otolaryngology, radiology, neurosurgery and vascular surgery to treat these patients.

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Liposarcoma of the retropharyngeal space

Ozawa Hiroyuki, Soma Keiko, Ito Mari, Ogawa Kaoru

Auris Nasus Larynx 34 ( 3 ) 417 - 421 2007.09

ISSN 0385-8146

Liposarcoma is a soft tissue malignant tumor that is common in adults, though the incidence of this type of tumor in the head and neck region is extremely low. Herein, we report a case of myxoid liposarcoma occurring in the retropharyngeal space. We were unable to make a proper diagnosis of this tumor prior to surgery because of the radiographic findings and the anatomical location resembled those of neurogenic tumor. Myxoid liposarcoma often recurs. So its excision must be carried out carefully and radical dissection is recommended. In the past, liposarcomas arising in the retropharyngeal space were not radically resected because the extent of resection in the head and neck area risked poor functional outcome. In the present case, functional resection and radiotherapy were performed and proved to be efficacious in that no recurrence was observed for 2 years. © 2007 Elsevier Ireland Ltd. All rights reserved.

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Decreased expression of connexin-30 and aberrant expression of connexin-26 in human head and neck cancer

Ozawa Hiroyuki, Matsunaga Tatsuo, Kamiya Kazusaku, Tokumaru Yutaka, Fujii Masato, Tomita Toshiki, Ogawa Kaoru

Anticancer Research 27 ( 4 B ) 2189 - 2195 2007.07

ISSN 0250-7005

Background: The relation of connexins and carcinogenesis has been studied in various organs and cell lines, with connexins currently being considered tumor suppressors. Materials and Methods: The expression of connexin-26 (Cx26) and connexin-30 (Cx30) in human head and neck carcinomas, as well as in adjacent normal mucosa, was evaluated by immunohistochemistry. Furthermore, the expression of these connexins with regard to apoptosis and cell differentiation was investigated. Results: In the cancer tissues, Cx30 expression was drastically reduced compared to apparently normal mucosa while Cx26 expression was almost the same. The intracellular distribution patterns of Cx26 and Cx30 in cancer cells differed between cancer locations. In the cancer tissues, expression of Cx26 and Cx30 was not related to apoptosis assessed by TdT-mediated dUTP-biotin nick end labeling (TUNEL) reaction or to cell differentiation assessed by immunoreaction to involucrin. Conclusion: The present results suggest that connexins may play a role in the carcinogenesis of head and neck cancer.

Clinical study of 28 cases of cervical lymph node metastasis from an unknown primary carcinoma

Tagawa Takamasa, Tomita Toshiki, Yamaguchi Hiroshi, Ozawa Hiroyuki, Sakamoto Koji, Ogawa Kaoru, Fujii Masato

Journal of Otolaryngology of Japan 110 ( 7 ) 503 - 505 2007.07

ISSN 0030-6622

From 1989 to 2005, 28 patients-20 men and 8 women-with cervical lymph node metastasis from an unknown primary carcinoma were treated and studied retrospectively. In histological diagnosis, open biopsy was conducted in 11 patients and non-open biopsy (FNA or frozen section diagnosis during surgery) in 17. Blind biopsy under general anesthesia was conducted in 10 patients, showing one primary tumor in the nasopharynx. Tonsillectomy for diagnosis was not done. In region of maximum-size lymph node metastasis, the upper cervical region accounted for 22 cases (79%). The N stage of cervical lymph nodes was as follows : N2a in 4, N2b in 14, N2c in 3, and N3 in 7. The histopathological diagnosis of cervical lymph node was as follows : squamous cell carcinoma in 21, adenocarcinoma in 3, mucoepidermoid carcinoma in 2, and others in 2. Therapy was as follows : only neck dissection in 7, neck dissection with postoperative radiation therapy in 13, and irradiation and chemotherapy in 8. All patients treated with irradiation and chemotherapy had been judged to be inoperable, Seven patients were found to have a subsequent primary tumor. Primary tumor sites were as follows : tonsils in 3 and upper gingiva, base of tongue, lung, and nasopharynx in 1 each. FDG-PET was conducted in 7 patients but revealed no primary tumor. Overall 5-year survival in this study was 46%. We should pay particular attention to the tonsils for detecting primary tumors in patients with cervical metastasis from an unknown primary carcinoma.

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Planned neck dissection after weekly docetaxel and concurrent radiotherapy for advanced oropharyngeal cancer

Tomita Toshiki, Ozawa Hiroyuki, Sakamoto Koji, Fujii Ryoichi, Ogawa Kaoru, Fujii Masato, Yamashita Taku, Shinden Seiichi

Journal of Otolaryngology of Japan 110 ( 3 ) 95 - 102 2007.03

ISSN 0030-6622

Small oropharyngeal carcinomas with advanced neck metastases (stage N2 or greater) are common. Patients with small T with large N oropharyngeal carcinoma have high rates of local control but lower rates of regional control when treated with chemoradiotherapy. Clinical assessment after chemoradiotherapy cannot ensure the absence of neck disease. In the last 5 years, we have treated patients with T1-2 with N2-3 oropharyngeal carcinoma with weekly docetaxel radiotherapy followed by planned neck dissection (PND). Our objectives were to clarify the pathologically complete response (CR) rate of neck metastasis after weekly docetaxel radiotherapy, to identify the clinical predictor of residual neck disease, and to determine the mobidity of planned neck dissection. After chemoradiotherapy, all 12 patients had a complete response at the primary site. We conducted 15 neck dissections. Of these, 6 (40%) had positive nodes. The pathological CR rate of neck metastasis was 58.3%, whereas overall 2-year neck control rate was 91.7%. These findings lend support to the role of PND after chemoradiotherapy in N2-3 neck disease. After chemoradiotherapy, clinical parameters including TN status, feasibility of chemoradiotherapy, largest lymph node size or size reduction in MRI, did not identify patients with residual neck disease. We conducted selective neck dissection (SND) in 80% of patients. SND as PND appears to be appropriate in this group of patients because of the low incidence of complications. A further cohort study including the comparison of PND nonenforcement group is necessary to clarify the validity of the addition of PND in weekly docetaxel radiotherapy.

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Pulse-oximetery is useful in determining the indications for adeno-tonsillectomy in pediatric sleep-disordered breathing

Saito Hideyuki, Araki Kouji, Ozawa Hiroyuki, Mizutari Kunio, Inagaki Kouji, Habu Noboru, Yamashita Taku, Fujii Ryouichi, Miyazaki Soichiro, Ogawa Kaoru

International Journal of Pediatric Otorhinolaryngology 71 ( 1 ) 1 - 6 2007.01

ISSN 0165-5876

Objective: Although first line therapy of sleep-disordered breathing (SDB) in children is adeno-tonsillectomy, the indications for this operation have not yet been clearly established. We investigated whether pulse-oximetry is useful for determining the optional treatment modality for pediatric SDB. Method: Two hundred and thirty-two children presenting with snoring and gasping had their oxygen saturation levels examined during sleep. Among them, 86 underwent on adeno-tonsillectomy and were evaluated pre- and post-surgery. We also examined 25 healthy children as controls. Results: Little desaturation was observed in healthy children. The difference in oxygen saturation levels of the patients between pre- and post-surgery was closely correlated with the pre-surgery levels. We examined the reaction operation characteristics and concluded that children with an oxygen desaturation index of 4% or more (ODI4) of more than 1.5 and/or ODI3 of more than 3.5 should undergo surgery. Conclusion: Pulse-oximetry is useful in determining the indications for adeno-tonsillectomy. © 2006 Elsevier Ireland Ltd. All rights reserved.

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Hypothyroidism after radiotherapy for patients with head and neck cancer

Ozawa Hiroyuki, Saitou Hideyuki, Mizutari Kunio, Takata Yasunori, Ogawa Kaoru

American Journal of Otolaryngology - Head and Neck Medicine and Surgery 28 ( 1 ) 46 - 49 2007.01

ISSN 0196-0709

We report on 2 cases of hypothyroidism presenting clinical symptoms that occurred after radiotherapy for cancer of the head and neck and on the results of estimating thyroid function in patients with head and neck cancer who received radiotherapy. The first patient underwent total laryngectomy for laryngeal cancer without sacrificing the thyroid gland and partial gastrectomy for gastric cancer. Radiotherapy of the neck was carried out postoperatively. Two years later, the patient developed chest pain; pericardial effusion was detected, leading to a diagnosis of myxedema caused by hypothyroidism. The second patient received radiotherapy alone for laryngeal cancer. Two months later, low serum sodium concentration and anemia were detected in this patient. The cause of these changes was subsequently found to be hypothyroidism. Based on our experience with these 2 cases, we measured thyroid function in 35 patients who had undergone neck radiation for head and neck cancer at our hospital over the past 10 years. Hypothyroidism was observed in 13 of the 35 patients (37%). The prevalence of hypothyroidism was 46% (6/13) for patients treated with both radiation and surgery, as compared with 32% (7/22) for those who received radiation alone. The risk factors responsible for hypothyroidism were not evident from the statistical analysis of these cases. We believe that thyroid function should be evaluated periodically in patients who have undergone neck radiation because it is often difficult to diagnose hypothyroidism only from clinical symptoms. © 2007 Elsevier Inc. All rights reserved.

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Oncocytic carcinoma of the parotid gland

Ozawa Hiroyuki, Fujii Masato, Matsunaga Tatsuo, Masuda Kanaka, Hirose Shigemichi, Taiji Hidenobu

Journal of Otolaryngology 35 ( 3 ) 189 - 192 2006.06

ISSN 0381-6605

Critical spontaneous rupture of a common carotid artery pseudo-aneurysm

Masuda Kanako, Ozawa Hiroyuki, Fujii Masato, Kimura Satoko, Nagasaki Kazuhito, Matsunaga Tatsuro, Tsunoda Koichi

Lancet 366 ( 9502 ) 2034 2005.12

ISSN 0140-6736

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Aphonia and dysphagia after total gastrectomy

Ozawa Hiroyuki, Kimura Satoko, Mizutari Kunio, Fujimine Takekatsu, Fujii Masato, Ikeuchi Syunji, Matunaga Tatsuo, Tsunoda Koichi

Acta Oto-Laryngologica 125 ( 11 ) 1244 - 1246 2005.11

ISSN 0001-6489

A 67-year-old male was referred to our otolaryngological clinic because of aphonia and dysphagia. His voice was breathy and he could not even swallow saliva following a total gastrectomy for gastric carcinoma performed 2 weeks previously. Laryngeal fiberscopy revealed major glottal incompetence when he tried to phonate. However, both vocal folds abducted over the full range during inhalation. The patient could not swallow saliva because of a huge glottal chink, even during phonation. Based on these findings, he was diagnosed as having bilateral incomplete cricoarytenoid dislocation after intubation. The patient underwent speech therapy; within 1 min his vocal fold movement recovered dramatically and he was able to phonate and swallow. There have been few case reports of bilateral cricoarytenoid dislocation, and no effective rehabilitation has been reported. We believe that our method of vocal rehabilitation serves as a useful reference for physicians and surgeons worldwide. © 2005 Taylor & Francis.

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High-quality video recording and monitoring system for endoscopes

Tsunoda Koichi, Tsunoda Atsunobu, Ozawa Hiroyuki, Fujimine Takekatsu

Laryngoscope 115 ( 8 ) 1520 - 1521 2005.08

ISSN 0023-852X

We have developed a new recording system for endoscope images with the popular mini digital video (mini DV) camera. A special adaptor screws onto the lens top, and either a flexible or rigid endoscope can be attached to the camera. Using this system, we can monitor not only the endoscopic images but also the patient's condition. Satisfactory images can be obtained even with the finest fiberscope. Nevertheless, our new system costs only $1,000. Therefore, the system is both cost-effective and useful for the outpatient clinic or casual setting or for house calls for the purpose of patient education. © 2005 The American Laryngological, Rhinological and Otological Society, Inc.

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Intramuscular myxoma of scalene muscle

Ozawa Hiroyuki, Fujii Masato, Tomita Toshiki, Ogawa Kaoru

Auris Nasus Larynx 31 ( 3 ) 319 - 322 2004.09

ISSN 0385-8146

Intramuscular myxoma is a benign mesenchymal tumor that commonly occurs in the larger skeletal muscles, and is rare in the head and neck. A case of intramuscular myxoma in the scalene muscle is described. This is the first report of this tumor arising in that muscle. It is difficult to diagnose pre-operatively from clinical features, CT scan and ultrasonography of the neck because of the lack of characteristic manifestation or radiographic features. Intramuscular myxoma has an infiltrative tendency, so there are several reports of recurrence because of incomplete excision or enucleation. In our case no recurrence was observed for 4 years, since the tumor was removed with the muscle adherent to it. © 2004 Elsevier Ireland Ltd. All rights reserved.

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Review of 26 Patients Operated on for Primary Hyperparathyroidism

Mizutari Kunio, Saito Hideyuki, Ozawa Hiroyuki, Inagaki Koji, Inoue Takahiro

Journal of Otolaryngology of Japan 106 ( 12 ) 1121 - 1126 2003

ISSN 0030-6622

The traditional surgical approach for primary hyperparathyroidism (PHP) is routine bilateral neck exploration. At Saiseikai Utsunomiya Hospital, however, unilateral exploration, and the direct resection of one gland is performed if single gland enlargement is suspected, based on the findings of several preoperative localization procedures. Here, we reviewed 26 patients who underwent single gland operations for PHP at our institution between 1993 and 2001. The 26 patients (21 women and 5 men) ranged in age from 20 to 79 years (mean, 54.8 years). None of the patients had multiple endocrine neoplasia (MEN), familial hypercalcemia, or malignant tumors. At least three preoperative localization procedures, such as ultrasonography, computed tomography, thalium technetium scanning, 99mTc sestamibi scintigraphy, or magnetic resonance imaging, were performed in each patient. A parathyroidectomy was then performed under general anesthesia. Contralateral exploration was not routinely performed. In addition, an intraoperative biopsy of the other glands was not performed. The following data were retrospectively collected in all patients: serum calcium, and the HS-PTH at one month and 6 months after the parathyroidectomy. All patients were normocalcemic, and the serum HS-PTH concentration significantly decreased in all patients after this operation. Patients were divided into two groups (adenoma group, n = 16; hyperplasia group, n = 6) and the data was analyzed according to the histological and pathological diagnosis. In both pathological groups, all patients were normocalcemic and the serum HS-PTH concentration was significantly lower after surgery. The serum HS-PTH concentration showed no significant difference between the adenoma group and the hyperplasia group at 6 months after surgery. No complications, including recurrent laryngeal nerve palsy or permanent hypocalcemia, were observed after surgery. In conclusion, if a single gland disease is suspected based on the findings of multiple preoperative localization procedures, resection of the enlarged gland alone appears to provide good results for the treatment of either adenoma or hyperplasia resulting in PHP. In addition, this procedure also reduces the occurrence of postoperative hypocalcemia, because the normal glands are not injured by the biopsy procedures.

Sensorineural hearing loss from suspected Wegener's granulomatosis; report of 2 cases

Ozawa Hiroyuki, Saitou Hideyuki, Mizutari Kunio

Practica Oto-Rhino-Laryngologica 96 ( 5 ) 397 - 404 2003

ISSN 0032-6313

2 cases of suspected Wegener's granulomatosis showing inflammation in the middle ear and progressive sensorineural hearing loss (SNHL) are reported. The first patient was a 73-year-old female who visited our hospital with a complaint of sudden onset of hearing loss. She had SNHL and administration of steroid hormone improved her hearing acuity temporarily, but then her hearing deteriorated. Subsequently she showed subglottic stenosis, pneumonia and saddle nose. The second patient was a 55-year-old male with otalgia and hearing loss. He had progressive SNHL and ear polyp, and then showed saddle nose. His hearing loss was almost fully recovered after treatment with cyclophosphamide and predonisolone. It was considered in these cases that sensorineural hearing loss had an autoimmune origin. Otitis media is well known as an otological manifestation of Wegener's granulomatosis, but SNHL is comparatively rare. Diagnosis of Wegener's granulomatosis was made by clinical symptoms because c-ANCA titers of our cases were negative, and histopathological studies were not typical. In these cases, they took predonisolone before diagnosis. We suggest that steroid hormones may suppress disease activity and make diagnosis difficult. It is important to look for this disease among SNHL patients and perform general examination in the early stage, because early therapy can lead to an improvement in the morbidity and survival of this disease.

Nocturnal Pulse Oximetry Diagnosis for Screening Pediatric Obstructive Sleep Apnea Syndrome

Saito Hideyuki, Yamashita Taku, Inagaki Koji, Habu Noboru, Araki Koji, Ozawa Hiroyuki, Mizutari Kunio

Journal of Otolaryngology of Japan 106 ( 12 ) 1127 - 1134 2003

ISSN 0030-6622

We evaluated the diagnostic value of pulse oximetry during sleep in pediatric obstructive sleep apnea syndrome (OSAS) caused by adenoid-tonsil hypertrophy. Subjects were 22 healthy children free of symptoms such as snoring, sleep apnea and oral breathing and 163 children suspected of OSAS with snoring or sleep apnea. Subjects were measured for percutaneous oxygen saturation (SpO₂) during sleep. Of those with suspected OSAS, 69 underwent adenotonsillectomy and were measured for SpO₂ both pre- and postoperatively, then pre- and postoperative measurements were compared. After measurement, we analyzed three parameters: lowest saturation (LSpO₂), the desaturation index, and total desaturation duration under 95% (TDD95). Few abnormal findings were seen in healthy children. We calculated the mean and standard deviation (SD) of each parameter and set borderlines of mean-2SD for LSpO₂ and mean + 2SD for ODI and TDD95. With these borderlines, 105 children for LSpO₂, 75 for ODI and 76 for TDD 95 were judged to be normal among the 163 with suspected OSAS. Histograms showed that the mode of each parameter was situated near the borderline. Comparison between pre- and postoperative measurements showed that the effect of the surgery strongly correlated with preoperative measurement in patients undergoing surgery. Assuming that a patient with postoperative improvement is positive, we calculated sensitivity and specificity for each borderline measurement. We found that if success is 100%, the borderline should be 87% for LSpO ₂, 3.5 for ODI, and 30.0 for TDD95. If success exceeds 90%, the borderline should be 90% for LSpO₂, 2.0 for ODI, and 7.0 for TDD95. We therefore conclude that measurement of SpO₂ during sleep is useful in screening for pediatric OSAS.

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