研究者詳細 - 西山　崇経

論文 - 西山　崇経

分割表示 155 件中 41 - 60 件目／全件表示 >>

術後咽頭皮膚瘻に対するパウチ法を用いた管理の有用性

松居祐樹, 西山崇経, 今西順久, 重冨征爾, 佐藤陽一郎, 猪狩雄一, 五島可奈子, 笠原健, 小澤宏之

日本耳鼻咽喉科頭頸部外科学会会報（(一社)日本耳鼻咽喉科頭頸部外科学会） 125 （ 3 ） 271 - 278 2022年03月

ISSN 2436-5793

縫合不全に伴う唾液漏出は頭頸部術後合併症の一つであり,救済処置として咽頭皮膚瘻を形成し二期的閉鎖を目指すことが多く,創部が安定し閉鎖術が行えるまでの期間は瘻孔からの唾液管理を要する.瘻孔に軟膏ガーゼを充填し,さらに上からガーゼで圧迫し,気管孔にカフ付きカニューレを留置する方法(以後,「従来法」)が一般的だが,度重なるガーゼと貼付テープの交換による疼痛や皮膚障害,カニューレ刺激による喀痰量増加,咳嗽誘発など患者負担が大きい.近年,患者負担軽減のためにさまざまな方法が報告されているが,咽頭皮膚瘻特有の構造的および性状的な問題点を解決できない例もあり,最適なパッキング方法とは言い難い.今回われわれは採尿バッグやストマパウチと粘土状皮膚保護剤を組み合わせた方法(以後,「パウチ法」)による管理を行った.パウチ法は粘土状皮膚保護剤による土手の成形と,パウチの面板の切り取り面積の調整により,瘻孔径を問わずさまざまな症例に柔軟に対応することができる汎用性の高い方法と考えられた.また,全例で交換頻度は3～4日毎,皮膚障害は軽度まで,カニューレは不要だった.パウチ法は従来法の欠点を補い,患者負担を軽減することができる方法だった.パウチ法の運用は,パウチ内に貯留する唾液管理は患者自身で対応可能であり,使用資材の取り扱いはストマ専従ナースとの協力が重要だった.(著者抄録)

Factors Influencing the Purchase Rate of Cartilage Conduction Hearing Aids

Nishimura T., Hosoi H., Sugiuchi T., Matsumoto N., Nishiyama T., Kenichi T., Sugimoto S., Yazama H., Sato T., Komori M.

Journal of the American Academy of Audiology （Journal of the American Academy of Audiology） 33 （ 1 ） 14 - 22 2022年01月

ISSN 10500545

Background: Innovated hearing aids (HAs), termed cartilage conduction hearing aids (CC-HAs), show good performance in patients with closed ears and continuous otorrhea. However, factors other than the ear condition that influence the purchase rate of CC-HAs remain unclear. Purpose: To identify the factors that influence the purchase rate of CC-HAs. Research Design: A correlational study. Study Sample: A total of 249 patients were enrolled. Data Collection and Analysis: The patients' demographics, clinical characteristics, outcomes, and CC-HA transducer types were compared. The data were analyzed for six groups classified based on the ear condition. Results: In the unilateral closed-ear group, the purchase cases were significantly younger than the nonpurchase cases (p < 0.05). Regarding the outcomes in the bilateral closed-ear group, the purchase cases showed significantly better-aided thresholds at 0.25 and 0.5 kHz than the nonpurchase cases. No significant differences in the functional gains and speech recognition scores were found between purchase and nonpurchase cases in all six groups. Regarding the transducer type, the continued-use rate of the simple transducer type was significantly lower in the bilateral chronic continuous otorrhea, bilateral open, and unilateral open groups. Conclusion: In the closed ears, no remarkable negative factors were found. Transducer type had a significant influence on the continued-use rate in the nonclosed ears including the ears with chronic continuous otorrhea, although the purchase rate of CC-HAs in the bilateral chronic continuous otorrhea group was comparable to the closed ears.

Access to Document (DOI)

A rare case of external ear canal stenosis caused by COVID-19-related arterial thrombosis

Hosoya M., Minami A., Nishiyama T., Tsuzuki N., Wakabayashi T., Oishi N.

Ear, Nose and Throat Journal （Ear, Nose and Throat Journal） 103 （ 1_suppl ） 1455613221097198 - 1455613221097198 2022年

ISSN 01455613

Thrombosis is a characteristic symptom of coronavirus disease 2019 (COVID-19). Here, we present a case of external ear stenosis caused by arterial thrombosis after COVID-19 infection. To the best of our knowledge, this is the first report of external ear stenosis related to COVID-19. A 62-year-old man presented with left hearing loss. The patient had a history of hospitalization for COVID-19 treatment 11 months prior to visiting our hospital. He had been experiencing ear fullness and tinnitus after COVID-19 treatment. Physical examination revealed severe left external ear canal stenosis with a subcutaneous mass. Surgical removal of the subcutaneous mass was performed. Histopathological analysis revealed that a subcutaneous thrombosis caused the external ear canal stenosis. This case describes an unusual case of external ear canal stenosis after COVID-19. Clinical and pathological findings indicate that COVID-19 affected the external ear canal. In addition, histopathological results confirmed the formation of arterial thrombosis in the temporal bone region after COVID-19 treatment. This case shows the broad range of body sites that can be involved with thrombotic events with COVID including the subcutaneous tissue around the outer ear. This observation would be helpful in investigating or explaining the various otological symptoms of COVID-19.

Access to Document (DOI)

Cricotracheostomy in a patient with severe kyphosis: A case report

Kasahara K., Nishiyama T., Shigetomi S., Ikari Y., Matsui Y., Ozawa H.

Ear, Nose and Throat Journal （Ear, Nose and Throat Journal） 103 （ 11 ） 1455613221077596 - 1455613221077596 2022年

ISSN 01455613

Cricotracheostomy is a useful surgical procedure for opening the airway in cases where conventional tracheotomy is difficult. This is a safe and easy technique involving removal of the anterior portion of the cricoid cartilage. Herein, we report the case of a patient with difficulty in neck extension due to severe kyphosis, who underwent cricotracheostomy. A 65-year-old woman developed dyspnea and was transported to our hospital. SpO2 was 60% (room air) and endotracheal intubation was performed. She was managed on ventilator. However, weaning off the ventilator was difficult, and endotracheal intubation was prolonged. Subsequently, the patient was referred to us for a tracheostomy. The patient was unable to maintain the supine position due to severe kyphosis, and computed tomography revealed that the brachiocephalic artery was running just below the thyroid gland. Therefore, conventional tracheostomy was difficult to perform, and we performed cricotracheostomy instead. After the cricotracheostomy, there were no tracheal problems, such as tracheal stenosis and stomal hemorrhage. Cricotracheostomy can be performed in cases where multiple anatomical difficulties may be faced in the tracheostomy site, as in this case. Furthermore, cricotracheostomy is beneficial for long-term airway management because it causes fewer complications compared to conventional tracheotomy.

Access to Document (DOI)

Inner ear salivary gland choristoma extending to the middle ear with congenital profound hearing loss and facial palsy: a case report

Yamanobe Y., Oishi N., Nishiyama T., Hosoya M., Ogawa K.

Journal of Otolaryngology - Head and Neck Surgery （Journal of Otolaryngology - Head and Neck Surgery） 50 （ 1 ） 25 - 25 2021年12月

ISSN 1916-0208

Background: Salivary gland choristoma (SGCh) is a rare benign tumor reported in several unusual sites, such as the gastrointestinal tract, the optic nerve, and the internal auditory canal, but never reported in the inner ear. Case presentation: An 8-year-old girl with a history of left profound congenital hearing loss presented to us with ipsilateral progressive severe facial nerve palsy (House-Brackmann Grade VI). The left tympanic membrane was swollen with a pulsatile tumor. Radiological investigations revealed a multilocular tumor in the inner ear extending into the middle ear and internal auditory canal (IAC). We performed a partial resection of the tumor by transmastoid approach to preserve the anatomical structure of the facial nerve. The tumor was pathologically diagnosed as SGCh. Two years after surgery, her facial function recovered to House-Brackmann Grade II and the residual tumor did not show regrowth on MRI. Conclusions: Although the natural course of this rare tumor is unknown, a partial resection is an acceptable treatment procedure when functional recovery of the facial nerve is anticipated. Graphical abstract: [Figure not available: see fulltext.]

Access to Document (DOI)

Severe sudden sensorineural hearing loss related to risk of stroke and atherosclerosis

Tsuzuki N., Wasano K., Oishi N., Hentona K., Shimanuki M., Nishiyama T., Hiraga Y., Shinden S., Ogawa K.

Scientific Reports （Scientific Reports） 11 （ 1 ） 20204 - 20204 2021年12月

The cause of idiopathic sudden sensorineural hearing loss (idiopathic SSNHL)—diagnosed after excluding other causes of hearing loss, such as SSNHL associated with vestibular schwannoma (VS)—is unknown. The presumed pathogenesis of idiopathic SSNHL includes circulatory disorders (e.g., cochlear infarction). We tested the hypothesis that patients with SSNHL who are at high stroke risk will have a lower rate of VS compared to those with low stroke risk. The rationale is that the primary cause of SSNHL in patients with high stroke risk might be a circulatory disturbance. We conducted a retrospective study in six hospitals. Our sampling of SSNHL patients included those diagnosed with idiopathic SSNHL and VS-associated SSNHL. SSNHL patients who had a head MRI were stratified by severity of hearing loss and evaluated for differences in the detection rate of VS between the high-scoring CHADS2 (CHADS2-H-), an index of stroke risk, and low-scoring CHADS2 (CHADS2-L-) groups. We identified 916 patients who met the inclusion criteria. For severe hearing loss, the CHADS2-H group had a significantly lower rate of VS than the CHADS2-L group (OR 0 [95% CI 0.00–0.612]; P = 0.007). These results indirectly support the hypothesis that a primary cause of severe idiopathic SSNHL in those at high risk of stroke might be a circulatory disorder.

Access to Document (DOI)

The Frequency Characteristic of Silicone Domes in Receiver in the Canal Hearing Aids

Ueno M., Shinden S., Suzuki D., Suzuki N., Nishiyama T., Oishi N., Ogawa K.

Journal of the American Academy of Audiology （Journal of the American Academy of Audiology） 32 （ 9 ） 556 - 561 2021年10月

ISSN 10500545

Background There are several types of silicone domes in receiver in the canal hearing aids (RICs), which have different occlusion levels. However, the frequency characteristics of each type of silicone dome are unclear. Purpose This study aimed to determine the frequency characteristics of three types of silicone domes (open domes, double-type power domes, and tulip domes) in RICs. Research Design This is an interventional study. Study Sample In total, 11 participants with a normal sense of hearing were prospectively enrolled. Intervention Participants were fitted with hearing aids, which were adjusted to similar settings, and only the silicone domes were changed. The acoustic gain of hearing aids was adjusted to 20 dB in the range of 250 Hz to 4 kHz using the 2-cc coupler. Data Collection and Analysis We measured the real-ear aided gain (REAG) for each type of silicone dome. In each frequency, we statistically compared the REAG of each type of dome. Acoustic gain using the Open Fit coupler of each type of dome was also measured. Results The REAG was obtained with no leakage with open domes only at 2 kHz, and with tulip domes and double-type power domes in the range of 1 to 2 kHz. Double-type power domes obtained significantly higher REAG than tulip domes at 250 and 500 Hz. Under the Open Fit coupler, all types obtained higher acoustic gain than the REAG. Conclusion This study provides the analysis of the frequency characteristics of silicone domes in RICs. The highest degree of occlusion was observed in double-type power domes, followed by tulip domes, and the lowest was observed in open domes.

Access to Document (DOI)

Three cases of otitis media caused by Mycobacterium abscessus subsp. abscessus: Importance of medical treatment and efficacy of surgery

Nishiyama Y., Nishiyama T., Kanzaki S., Oishi N., Fujioka M., Yamada H., Ebisuno C., Kaiho M., Uwamino Y., Fukano H., Hoshino Y., Hasegawa N., Ogawa K.

Journal of Infection and Chemotherapy （Journal of Infection and Chemotherapy） 27 （ 8 ） 1251 - 1257 2021年08月

ISSN 1341321X

This study aimed to assess the clinical presentation, antibiotic therapy, surgery, and outcomes in patients with otitis media caused by Mycobacterium abscessus subsp. abscessus and discuss the efficacy of surgery. This is a retrospective case review of three patients diagnosed with otomastoiditis caused by M. abscessus subsp. abscessus. All patients had refractory otorrhea. One patient had granulation tissue in the tympanic membrane. They received medical treatment and underwent surgery. Otorrhea was resolved several months after the initiation of long-term multiantibiotic therapy in all cases. The timing of surgery varied among patients. Before initiating antibiotic therapy, mastoidectomy was performed to achieve definitive diagnosis in two patients, and wound dehiscence developed in these patients. Two patients underwent debridement after the initiation of multiantibiotic therapy. After antibiotic administration, tympanoplasty was performed to improve hearing in one patient. All patients achieved culture negativity after treatment, and no recurrences have been noted. From three cases, it is suggested that the mainstay of treatment for M. abscessus subsp. abscessus is long-term multiantibiotic therapy, and surgery itself may have little effect on achieving ear dryness. Thus, in most patients, drug therapy should be prioritized. Considering postoperative complications, surgery before achieving ear dryness should be avoided, except in emergency cases. In addition, if the diagnosis is not confirmed by repeated bacteriological tests, mastoidectomy should be performed to collect specimens. Tympanoplasty for hearing loss or eardrum perforation is recommended after discontinuation of medications.

Access to Document (DOI)

Who are good adult candidates for cartilage conduction hearing aids?

Nishiyama T., Oishi N., Ogawa K.

European Archives of Oto-Rhino-Laryngology （European Archives of Oto-Rhino-Laryngology） 278 （ 6 ） 1789 - 1798 2021年06月

ISSN 09374477

Purpose: Cartilage conduction hearing aids (CC-HAs) are novel hearing aids using the third hearing pathway of cartilage conduction. We assessed the efficacy of CC-HAs in adult hearing-loss patients who had various anatomical conditions of their ear canal(s) and determined who are good candidates for CC-HAs. Methods: Patients (n = 37) were categorised into three groups of participants based on ear canal anatomy: (1) canal stenosis; (2) abnormal canal; (3) normal canal. After a 1-month free trial of normal usage, CC-HA-aided and unaided hearing thresholds (43 fitted ears) were determined using standard audiograms, after which participants could choose to purchase the device or not. Group and subgroup purchase rates were calculated along with the purchase reason (or not). Subgroup binary analysis of purchase rates was done according to hearing loss severity (< 70 dB and ≥ 70 dB) of unaided average air conduction (AC) hearing thresholds. Results: CC-HA provided hearing improvements in all frequencies within each group. Overall, 60.47% of participants purchased a CC-HA after the trial. Over 70% participants with canal stenosis purchased CC-HAs, regardless of their AC hearing thresholds (severe vs. mild), and significantly more mild-loss participants in the abnormal canal group purchased their trial CC-HA compared to severe-loss participants (85.71% vs. 20%). Conclusion: Adult patients with ear canal stenosis or closure are the best candidates for CC-HAs, regardless of their hearing thresholds. Patients with more severe hearing loss accompanied by ear canal anomalies and patients with normal canal anatomy may not be good candidates.

Access to Document (DOI)

Efficacy of cartilage conduction hearing aids in children

Nishiyama T., Oishi N., Ogawa K.

International Journal of Pediatric Otorhinolaryngology （International Journal of Pediatric Otorhinolaryngology） 142 110628 - 110628 2021年03月

ISSN 01655876

Objectives: Cartilage conduction hearing aids (CC-HAs) are novel hearing aids that use the third hearing pathway of cartilage conduction. We assessed the efficacy of CC-HAs and the hearing effects and safety of additional tape compression over the transducer in children with hearing loss. Methods: The patients (n = 42) underwent a one-month free trial of CC-HAs. Forty of them were patients with auditory canal atresia or stenosis. CC-HA-aided and unaided hearing thresholds (48 fitted ears) were determined using standard audiograms, after which participants could choose to purchase the device or not. We calculated the purchase rates and compared the patient characteristics between the purchase and non-purchase groups along with the purchase reason (or not). We applied additional tape compression over the CC-HA transducer and assessed the hearing effects and side effects. Results: CC-HA led to hearing improvements at all frequencies. Overall, 72.92% of participants purchased a CC-HA after the trial. By applying additional tape compression over the CC-HA transducer, the stability and hearing gains were improved mainly at low frequencies, and no side effects such as dermatitis were observed. Conclusions: CC-HAs are efficacious in producing hearing improvements in children, especially in patients with atresia or canal stenosis who cannot use air conduction hearing aids. Furthermore, we found that the additional tape compression over the transducer was an easy and a safe method for improving the hearing effects and stability of the CC-HA.

Access to Document (DOI)

外耳道癌症例22耳の検討

鈴木成尚, 大石直樹, 小澤宏之, 神崎晶, 藤岡正人, 西山崇経, 野口勝, 細谷誠, 関水真理子, 斎藤真, 小川郁

日本耳鼻咽喉科学会会報（(一社)日本耳鼻咽喉科頭頸部外科学会） 124 （ 3 ） 197 - 204 2021年03月

ISSN 0030-6622

外耳道癌の確立した治療法はないが、切除可能例では手術が優先される。当院ではT1〜T3症例に手術、T4症例に化学放射線療法(CCRT)を選択してきた。側頭骨外側切除術は伝音難聴が必発のため聴覚機能が犠牲になるとされてきたが、術後補聴による聴覚の再獲得に取り組んでいる。当科での短期成績の検討を行った。2012年1月〜2018年6月に初回治療を行った外耳道癌21例22耳を対象とした。改訂Pittsburgh分類にてT1が4耳、T2が9耳、T3が6耳、T4が3耳だった。17耳に手術、5耳にCCRTか重粒子線治療を施行した。側頭骨外側切除術を施行したT3例6耳中3耳で断端陽性となったが、T1・T2例ではすべて陰性だった。2年生存率はT1が100%、T2が88.9%、T3が83.3%、T4が100%だった。聴器合併症は側頭骨外側切除術例では伝音難聴のみだったが、放射線治療例では骨導低下、外耳道狭窄、難治性耳漏などを認めた。術後に軟骨伝導補聴器を試聴した5例中4例で常時装用となった。術前CTで腫瘍が鼓膜をわずかに越えるのみ、造影MRIで外耳道前方の軟部組織の境界が明瞭な症例では切除断端は陰性であり、側頭骨外側切除術の良い適応であった。そのほかのT3・T4症例ではCCRTが第一選択と考えられた。放射線の難治性合併症を考慮すると、側頭骨外側切除術後に補聴を行う治療では聴覚を有効活用できた。(著者抄録)

Deficiency of large tumor suppressor kinase 1 causes congenital hearing loss associated with cochlear abnormalities in mice

Nishiyama T., Fujioka M., Saegusa C., Oishi N., Harada T., Hosoya M., Saya H., Ogawa K.

Biochemical and Biophysical Research Communications （Biochemical and Biophysical Research Communications） 534 921 - 926 2021年01月

ISSN 0006291X

Mammalian auditory hair cells are not spontaneously replaced. Their number and coordinated polarization are fairly well-maintained and both these factors might be essential for the cochlear amplifier. Cell cycle regulation has critical roles in regulating appropriate cell size and cell number. However, little is known about the physiological roles of the Hippo pathway, which is one of the most important signaling cascades that regulates cell growth, differentiation, and regenerative capacity in the cochlear sensory epithelium. Herein, we investigated the in vivo role of the large tumor suppressor 1 (LATS1), an essential kinase in the Hippo/yes-associated protein pathway, in the cochlea using the LATS1 knockout mice. LATS1 was expressed in hair cells and supporting cells. It was strongly expressed on the surface of the cuticular plate of the organ of Corti. We found that LATS1 knockout caused congenital hearing loss due to the irregular orientation and slightly reduced number of hair cells, whereas the number of supporting cells remained unchanged. On the surface of the hair cells, the kinocilium and stereocilia were dispersed during and after morphogenesis. However, the expression of the receptor-independent polarity regulators, such as Par3 or Gαi, was not affected. We concluded that LATS1 has an indispensable role in the maturation of mammalian auditory hair cells, but not in the development of the supporting cells, and thus, has a role in the hearing acquisition.

Access to Document (DOI)

Management of tinnitus in patients with vestibular schwannoma who underwent surgical resection

Kitamura M., Oishi N., Suzuki N., Kojima T., Nishiyama T., Noguchi M., Hosoya M., Ogawa K.

European Archives of Oto-Rhino-Laryngology （European Archives of Oto-Rhino-Laryngology） 278 （ 11 ） 4243 - 4249 2021年

ISSN 09374477

Purpose: To evaluate tinnitus and its management in patients with vestibular schwannoma (VS) who underwent surgery, we investigate the effect of surgical approach or residual hearing on tinnitus severity and the effects of intervention for tinnitus including educational counseling, sound therapy using hearing aids (HAs), and medication (selective serotonin reuptake inhibitors, and SSRIs). Methods: Seventy-one subjects of VS patients who underwent surgery were included. Their tinnitus severity was evaluated using the Japanese version of the Tinnitus Handicap Inventory (THI). The relationships between postoperative THI scores and surgery types or residual hearing levels were examined. We also examined longitudinal changes in THI scores and the efficacy of the intervention. Results: Surgery approach, hearing preservation or hearing loss surgery, and residual hearing levels were not significantly related to the postoperative tinnitus severity. In 71 cases, 45 cases did not require any management for tinnitus. On the contrary, 26 patients had at least one episode of tinnitus distress (THI score was greater than or equal to 18). Educational counseling alone was found to be effective in 17 cases out of the 26 cases, and the remaining 9 cases required more intervention than educational counseling alone. We selected sound therapy with HA for 7 cases and administration of SSRI for 2 cases, which was found to be highly effective in 8 cases. Conclusion: Based on the present study, we consider that appropriate management may be possible for tinnitus in the majority of VS patients who underwent surgery.

Access to Document (DOI)

Cartilage Conduction Hearing Aid Fitting in Clinical Practice

Nishimura T., Hosoi H., Sugiuchi T., Matsumoto N., Nishiyama T., Kenichi T., Sugimoto S., Yazama H., Sato T., Komori M.

Journal of the American Academy of Audiology （Journal of the American Academy of Audiology） 32 （ 6 ） 386 - 392 2021年

ISSN 10500545

Background ?Cartilage conduction hearing aids (CCHAs) were newly devised and spread fast in Japan since their launch in 2017. However, little knowledge is available for this new device. Purpose ?The aim of this study was to establish the knowledge of CCHAs and suggest their indication. Research Design ?Correlational study. Study Sample ?A total 256 patients were registered. Data Collection and Analysis ?The fitting of CCHAs was surveyed in nine institutions. The outcomes were assessed by audiometric tests. The patients were classified into seven groups, depending on the ear conditions. The clinical characteristics, assessment results, and purchase rates were compared among the groups. The assessment results of CCHAs were also compared with those of previously used hearing aids. Results ?Most patients who used CCHAs were classified into the bilateral closed (aural atresia or severe stenosis) ear (n = 65) or unilateral closed ear (n = 124) groups. The patients in these groups achieved good benefits that resulted in a high purchase rate. The bilateral continuous otorrhea group also supported a high purchase rate, although the benefits of CCHAs were not always excellent. In contrast, the purchase rate was poor in the patients who could use air conduction hearing aids (ACHAs) without absolute problems. As for using a CCHA as a contralateral routing of signals hearing aid, the benefits depended on the patients. Conclusions ?CCHAs are considered as a great option not only to the patients with closed ears but also to those who had difficulties in ACHAs usage.

Access to Document (DOI)

A Retrospective Analysis of 22 Cases with Carcinomas of the External Auditory Canal

Suzuki N., Oishi N., Ozawa H., Kanzaki S., Fujioka M., Nishiyama T., Noguchi M., Hosoya M., Sekimizu M., Saito S., Ogawa K.

Journal of Otolaryngology of Japan （Journal of Otolaryngology of Japan） 124 （ 3 ） 197 - 204 2021年

ISSN 00306622

Carcinoma of the external auditory canal is a rare tumor, accounting for about 1% of all head and neck cancers. Although no treatment method has been established yet, surgical treatment is the primary treatment method in cases where resection is possible. At our institution, we adopt surgical treatment, mainly lateral temporal bone resection （LTBR）, for cases with T1―T3 disease, and chemoradiation therapy（CCRT）for cases with T4 disease, as the treatment of first choice. We have adopted cartilage conduction hearing aids（CC―HAs）in some cases following LTBR. We examined the short―term outcomes, at two years, in the patients treated at our department. This study was a retrospective case review of 22 ears with carcinoma of the external auditory canal in 21 patients who underwent initial treatment at our institution between January 2012 and June 2018. The observation period was 2 to 81 months（median 26 months）. The tumors were analyzed using the modified Pittsburgh tumor staging system. The tumor T stage was T1 in four ears, T2 in nine ears, T3 in six ears, and T4 in three ears. CCRT was performed in three ears with T4 disease and one ear with T2 disease, heavy ion radiotherapy was performed in one ear with T2 disease, and surgery（LTBR in 16 ears and partial external auditory meatus resection in one ear）was performed for all the other cases. The surgical margin after LTBR was positive in three out of six cases with T3 disease and negative in all of the cases with T1 and T2 disease. The positive surgical margin was mainly found in the medial wall of the tympanic cavity or cartilaginous portion of the external acoustic meatus. The overall 2―year survival rate was 87.4%; the rate was 100% in the T1 cases, 87.5% in the T2 cases, 75.0% in the T3 cases, and 100% in the T4 cases. Four out of five patients who tried CC―HAs continued to use them after the LTBR. The indication for LTBR should be carefully judged in cases with T3 disease. The appropriate indication for LTBR in cases with T3 disease are: 1）a small amount of soft tissue shadow beyond the tympanum in the preoperative CT, and/ or 2）a clear boundary between the tumor and the soft tissue around the external acoustic meatus in the preoperative enhanced MRI. In cases with T3 disease not fulfilling these criteria, CCRT should be selected as the treatment of first choice. However, considering the side effects after CCRT, including sensorineural hearing loss and persistent otorrhea in some cases, LTBR with postoperative CC―HAs is one of the optimal treatment options that would allow the remaining hearing ability to be utilized.

Access to Document (DOI)

Validation and multidimensional analysis of the japanese penn acoustic neuroma quality-of-life scale

Nishiyama T., Oishi N., Kojima T., Kasuya K., Noguchi M., Ishikawa T., Hosoya M., Ogawa K.

Laryngoscope （Laryngoscope） 130 （ 12 ） 2885 - 2890 2020年12月

ISSN 0023852X

Objectives: In the management of vestibular schwannoma (VS), patient-perceived outcomes should be given as much attention as physician-reported objective outcomes. Concomitant symptoms can be annoying for sufferers, lowering quality of life (QoL). However, it is difficult to determine the degree to which these symptoms lower QoL using only objective measures. The Penn Acoustic Neuroma Quality of Life Scale (PANQOL) is a validated disease-specific questionnaire commonly used to assess QoL in VS patients. It was developed and published in English. In this study, we translated the PANQOL questionnaire into Japanese and validated its reliability and utility. We also evaluated patient factors that could influence PANQOL scores. Study Design: Cross-sectional study. Methods: Seventy-two VS patients monitored conservatively were included in this study. They were assessed using the Japanese versions of PANQOL (PANQOL-J) and questionnaires about specific symptoms related to VS. The PANQOL questionnaire was translated into Japanese according to the accepted standards. The reliability and utility of the PANQOL-J questionnaire, as well as the relationship with VS-specific symptoms, were statistically analyzed. Results: The mean total score was 78.7. Almost all of its domains had good internal consistency. Most PANQOL-J domains were related to those of the Short Form-36, with the exception of facial dysfunction domain. Scores of all PANQOL-J domains were comparable to scores of other questionnaires related to the VS-specific symptoms. Our analyses indicated tinnitus or facial palsy might affect the PANQOL-J total score. Conclusions: We confirmed the validity of the Japanese version of PANQOL questionnaire and its reliability and utility in the management of VS symptoms concerning facial function. Level of Evidence: 4 Laryngoscope, 2020.