Otorhinolaryngology
Magnetic resonance imaging (MRI) sometimes detects abnormalities of the internal auditory meatus and labyrinth. The abnormalities may include vestibular schwannoma,
labyrinthitis, inner ear hemorrhage, inner ear anomalies or brain infarction in patients with sudden sensorineural hearing loss.
In Nagoya University Hospital, detailed evaluation of the inner ear may be performed using three-dimensional FLAIR (3D-FLAIR) MRI.
In patients with sudden sensorineural hearing loss, this technique allows hemorrhage or areas where high levels of protein are deposited to be detected in the inner ear.
Ordinary MRI may fail to identify these problems.
Application of real and virtual endoscopy for cochlear implantation
We use flexible fiber optic endoscopy (real endoscopy) and virtual endoscopy during cochlear implantation. Real and virtual endoscopy are used both to properly insert electrodes within the cochlea and for preoperative and intraoperative investigation of cochlear pathology due to various etiologies. We have published our data measuring cochlear blood flow in patients receiving cochlear implants. Real and virtual cochlear endoscopy are used for internal physiological evaluations in both normal and pathological circumstances, and to assist surgery during cochlear implantation.
Blood flow measurements in the ears of patients receiving cochlear implants
Cochlear blood flow can be measured with a laser-Doppler flow meter in patients receiving cochlear implants in Nagoya University Hospital. No adverse effects occur with this treatment. We have published our cochlear blood flow research work in well-recognized medical journals.
Intratympanic dexamethasone therapy for treatment of sudden deafness
Patients with sudden deafness, who have not recovered adequately after receiving a conventional cocktail infusion therapy including steroids, are treated by intratympanic injection of dexamethasone (4 mg/ml). This therapy delivers a high concentration of steroid directly to the inner ear and avoids systemic complications of steroid treatment. We recently reported that six of 23 patients who had received this injection as a salvage treatment registered improved hearing.
Diagnosis, using preserved umbilical cords, of congenital cytomegalovirus infection in patients with sensorineural hearing loss
Cochlear blood flow can be measured with a laser-Doppler flow meter in patients receiving cochlear implants in Nagoya University Hospital. No adverse effects occur with this treatment. We have published our cochlear blood flow research work in well-recognized medical journals.
Intratympanic gentamicin therapy for the treatment of Meniere’s disease and delayed endolymphatic hydrops
We investigated the long-term (more than one year) results of intratympanic gentamicin injections after treatment for intractable Meniere’s disease or delayed endolymphatic hydrops in patients of the Nagoya University Hospital. Thirty-five patients (15 men and 20 women) were evaluated after an average of six injections. The mean age was 44.5 years and the mean follow-up period was 68.2 months. A formula expressing the effect of treatment was developed based on AAOHNS criteria. Data from more than 12 months of treatment were compared with those from the 6 months before the treatment began. The efficacy rate of this treatment for definitive vertigo spells was 97% (control rate 69%), and the efficacy rate for adjunct vertigo spells was 74%. The average hearing levels at five frequencies (250 Hz, 500 Hz, 1 kHz, 2 kHz and 4 kHz) were 68.5 dB before treatment and 74.0 dB after treatment.
Laryngeal function preservation therapy
Even if cancer is progressive, we view chemoradiotherapy positively and preserve the larynx whenever possible. When chemotherapy is not enough, we are forced to operate, but we perform only hemilaryngectomy or subtotal laryngectomy whenever possible. When total laryngectomy cannot be avoided, we perform the TE shunt, aiming at a high quality of phonic acquisition. We also treat advanced thyroid cancers that have infiltrated the larynx, trachea or the recurrent laryngeal nerve. In this work, we aim at complete resection and preservation or reconstruction of laryngeal function.
Function preservation treatment for advanced oral or oropharyngeal carcinoma
We operate, in cooperation with a speech pathologist, to achieve maximal preservation of both speech and swallowing. With the help of a 2005-2006 grant-in-aid for cancer research from the Ministry of Health, Labour and Welfare, allowing us to identify head and neck tumor therapies preserving larynx function, we have studied the connection between dysphagia occurring after head and neck cancer treatment and other clinical problems.
Surgical treatment of skull base tumors
Craniofacial surgery is sometimes needed in advanced cases of maxillary cancer, carcinoma of the external acoustic meatus, cancer of the parotid gland or cancer of the epipharynx. These were once considered inoperable areas, but abscission by standard operative methods is now possible through the cooperation of a craniofacial surgeon, a plastic surgeon and a neurosurgeon. Some 122 malignant tumor patients were registered in our database of malignant head and neck tumors during 2005, of whom 114 received surgical attention. These included 29 patients who received free flap reconstructions and 17 patients who underwent craniofacial surgery.
Navigation surgery
We use a computerized optical navigation system (Evans-E, Tomiki, Kanazawa, Japan) mainly for nasal surgeries. Patients with ethmoid sinusitis or cysts extending to the orbits benefit from this technique, as do patients with multiple postoperative maxillary cysts, including bony septa. Patients with refractory frontal sinusitis or cysts requiring median drainage are also assisted by this technology. In all these examples, the navigation system helps to avoid complications during operations.
Less invasive surgical treatment of obstructive sleep apnea hypopnea syndrome
We investigated the short-term effects of nasal surgery (submucous resection of the nasal septum, inferior tubinectomy) and simple tonsillectomy on obstructive sleep apnea hypopnea syndrome (OSAHS). We found that nasal surgery resulted in reduced nasal resistance and a consequent improvement in ability to tolerate continuous positive airway pressure in OSAHS patients with severe nasal obstructions. Further, we have published that simple tonsillectomy is an effective treatment for OSAHS in patients with both tonsillar hypertrophy and a low body mass index (< 25 kg/m2). Tonsillectomy also helped patients to tolerate continuous positive airway pressure.
