A case of hematohidrosis successfully treated with a beta-blocker. Clinical case reports,11(6):e7337 2023(Jun.) Author:Yoshikazu Sha; Hidekane Yoshimura; Shoji Saito; Ryosuke Kitoh; Yutaka Takumi Abstract:Hematohidrosis is a rare disorder characterized by bloody sweating on the skin without trauma. The ear, nose, and other facial areas are the most commonly affected sites. This study shows usefulness of beta-blockers in the treatment of hematohidrosis.
Prognostic significance of pre- and post-treatment hematological biomarkers in patients with head and neck cancer treated with chemoradiotherapy. Scientific reports,13(1):3869-3869 2023(Mar. 08) Author:Yoh-Ichiro Iwasa; Moeka Shimizu; Kazuki Matsuura; Kentaro Hori; Ken Hiramatsu; Kenjiro Sugiyama; Yoh Yokota; Tomohiro Kitano; Ryosuke Kitoh; Yutaka Takumi Abstract:This study aimed to investigate the prognostic value of hematological biomarkers measured before and after treatment in patients with head and neck cancer (HNC). This study reviewed 124 patients with HNC who received chemoradiotherapy. Hematological biomarkers assessed before and after treatment were investigated. The pretreatment C-reactive protein/albumin ratio (pre-CAR) and post-treatment prognostic nutritional index (post-PNI) showed the highest area under the curve with cutoff values of 0.0945 and 34.9, respectively. Patients in the high pre-CAR group showed significantly worse prognosis than those in the low pre-CAR group with respect to the progression-free survival (PFS) (3-year PFS: 44.8% vs. 76.8%, p < 0.001) and overall survival (OS) (3-year OS: 65.8% vs. 94.0%, p < 0.001). Patients in the low post-PNI group showed significantly worse prognosis than those in the high post-PNI group with respect to the PFS (3-year PFS: 58.6% vs. 77.4%, p = 0.013) and OS (3-year OS: 75.2% vs. 96.9%, p = 0.019). Multivariate analysis revealed that advanced N stage (p = 0.008), high pre-CAR (p = 0.024), and low post-PNI (p = 0.034) were significantly associated with poorer OS. We suggest that the evaluation of hematological markers before and after treatment is useful for predicting disease progression and survival.
Sound localization in patients with idiopathic sudden hearing loss. Acta oto-laryngologica,143(1):43-48 2023(Jan.) Author:Ryosuke Kitoh; Yutaka Takumi; Shin-Ya Nishio; Shin-Ichi Usami Abstract:BACKGROUND: Patients with unilateral hearing loss have difficulty localizing sound. Severe-to-profound unilateral hearing loss is most commonly caused by idiopathic sudden sensorineural hearing loss (SSNHL). AIMS/OBJECTIVES: To assess the sound localization ability of patients with idiopathic unilateral SSNHL and examine the factors affecting the results. MATERIAL AND METHODS: We retrospectively enrolled 141 patients with idiopathic unilateral SSNHL. The assessment stimuli were speech-shaped noise from one of the nine loudspeakers in a 180° arc. Multiple regression analysis was used to examine the factors that affected sound localization ability. RESULTS: There was a strong correlation between the hearing level on the affected side post-treatment and the deviation score as the index of sound localization ability. The results of the multiple regression analysis suggested that sound localization may be partially affected by hearing level on the unaffected side and age. CONCLUSIONS AND SIGNIFICANCE: The results showed that sound localization ability decreased in idiopathic SSNHL patients with severe-to-profound hearing loss post-treatment. This study provides important data for future interventions for unilateral hearing loss, including cochlear implants.
Impact of Low Skeletal Muscle Mass on the Prognosis of Patients with Head and Neck Cancer Treated Nonsurgically. ORL; journal for oto-rhino-laryngology and its related specialties,85(1):36-43 2023 Author:Yoh-Ichiro Iwasa; Ryosuke Kitoh; Ken Hiramatsu; Kenjiro Sugiyama; Kizuki Watanabe; Rika Yasukawa; Jun Shinagawa; Hiroki Miyajima; Yoh Yokota; Masafumi Kobayashi; Tomohiro Kitano; Kentaro Mori; Yutaka Takumi Abstract:INTRODUCTION: Sarcopenia, characterized by low skeletal muscle mass, and the outcome of cancer therapy are closely related based on recent research. This study aimed to evaluate the correlation between skeletal muscle mass and prognosis in head and neck cancer (HNC) patients. METHODS: In this study, 51 male patients with HNC treated nonsurgically between January 2016 and April 2018 at Shinshu University Hospital were evaluated. Skeletal muscle mass was assessed using bioelectrical impedance analysis, and the skeletal mass index (SMI) was calculated to classify the patients. RESULTS: The low-SMI group had a significantly worse overall survival (OS) than the normal-SMI group (3-year OS: 72.0% vs. 93.0%, p = 0.014), and there was a trend toward worse progression-free survival (PFS) in the low-SMI group (3-year PFS: 49.6% vs. 79.3%, p = 0.064). Multivariate analysis also showed that low SMI (p = 0.04) and severe N stage (p = 0.009) were significantly associated with poorer OS. CONCLUSION: The pretreatment assessment of SMI using bioelectrical impedance analysis is useful for identifying patients with poor prognoses. To improve the treatment outcome in HNC, we need to think of the intervention, such as cancer rehabilitation and nutritional support, during or before treatment, especially for patients with low SMI.
Perioperative management of a patient with a giant thyroglossal duct cyst: a case report. Journal of surgical case reports,2022(6):rjac309 2022(Jun.) Author:Yoh-Ichiro Iwasa; Kentaro Hori; Ken Hiramatsu; Yoh Yokota; Tomohiro Kitano; Ryosuke Kitoh; Yutaka Takumi Abstract:Thyroglossal duct cysts (TGDC) are the most common type of congenital neck masses, which generally present in young adults. We present a rare case of a giant TGDC in a 77-year-old patient who required atypical perioperative management. The patient presented with a large soft mass on his anterior neck. Computed tomography showed a lobulated cystic mass measuring 18 × 16 cm, extending from the tongue base to the inferior level of the clavicle. Because difficult intubation was expected, the cyst was punctured and most of the fluid was drained prior to surgery. The swelling of the tongue base was remarkably reduced, and intubation was performed safely. The cyst was extracted using the Sistrunk procedure and tracheotomy was performed. Histopathological examination confirmed the diagnosis of TGDC. Preoperative volume reduction of the cyst and tracheotomy should be considered for oral intubation and postoperative airway management, respectively, in patients with large TGDC.
Impact of upgraded radiotherapy system on outcomes in postoperative head and neck squamous cell carcinoma patients. Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology,27(6):954-962 2022 Author:Keiichiro Koiwai; Dai Hirasawa; Miyu Sugimura; Yuuki Endo; Kai Mizuhata; Hironobu Ina; Ayumu Fukazawa; Ryosuke Kitoh; Hironori Sakai; Yasunari Fujinaga Abstract:BACKGROUND: This study was performed to evaluate the impact of upgrade of radiotherapy system, including launch of intensity-modulated radiation therapy (IMRT), on the therapeutic outcomes. MATERIALS AND METHODS: Patients with head and neck (H&N) squamous cell carcinoma (SCC) who underwent postoperative radiotherapy at our hospital between June 2009 and July 2019 were retrospectively reviewed. In July 2014, we converted the radiotherapy technique for these patients from a 3-dimensional conformal radiotherapy (3D-CRT) to IMRT, along with the adoption of a meticulous planning policy and a few advanced procedures, including online imaging guidance. RESULTS: A total of 136 patients (57 treated with the previous system and 79 treated with the upgraded system) were reviewed. There were significantly more patients with extracapsular extension in the upgraded-system group than the previous-system group (p = 0.0021). There were significantly fewer patients with ≥ Grade 2 acute and late adverse events in the upgraded-system group than the previous-system group. The differences in progression-free survival (PFS), distant metastasis-free survival (DFFS), locoregional progression-free survival (LRPFS), and overall survival (OS) between the two groups were not statistically significant (p = 0.8962, 0.9926, 0.6244, and 0.4827, respectively). Multivariate analysis revealed that the upgrade had neither positive nor negative impact on survival outcomes. Extracapsular extension was independently associated with decreased LRPFS and OS (p = 0.0499 and 0.0392, respectively). CONCLUSIONS: The IMRT-centered upgrade was beneficial for the postoperative patients with H&N SCC, because survival outcomes were sustained with less toxicities.
Speech perception in noise in patients with idiopathic sudden hearing loss. Acta oto-laryngologica,142(3-4):302-307 2022 Author:Ryosuke Kitoh; Shin-Ya Nishio; Shin-Ichi Usami Abstract:BACKGROUND: Patients with unilateral hearing loss have difficulties perceiving speech in a noisy environment. Unilateral severe to profound hearing loss is most commonly caused by idiopathic sudden sensorineural hearing loss (SSNHL). OBJECTIVES: To assess speech perception in noise among patients with idiopathic unilateral SSNHL, and examine the factors affecting the results. MATERIAL AND METHODS: We retrospectively enrolled 93 patients with idiopathic unilateral SSNHL. The speech signal was presented at a constant sound pressure level, while the noise signal varied from +5 dB to -5 dB signal-to-noise ratio (SNR) in units of 5 dB (S0/Nhe). RESULTS: As the SNR decreased, the percentage of correct answers also decreased. The correct answer rate decreased with increased hearing level at post-treatment. There was a correlation between age and speech perception, especially when dividing the patients into two groups: <65 years old and ≥65 years old. CONCLUSIONS AND SIGNIFICANCE: The results showed that speech perception clearly decreased in a noisy environment rather than in a quiet environment, and the correct answer rate of the speech perception test in noise was significantly correlated with hearing level at post-treatment. This study provides important data for future interventions for unilateral hearing loss, including cochlear implants.
Factors Affecting Nivolumab Therapy Outcome in Patients with Head and Neck Cancer: A Single-Center Analysis. Oncology,100(4):203-211 2022 Author:Yoh-Ichiro Iwasa; Yoh Yokota; Ryosuke Kitoh; Kentaro Mori; Keita Tsukada; Nodoka Sekiguchi; Toshirou Fukushima; Takashi Kobayashi; Shintaro Kanda; Yutaka Takumi; Tomonobu Koizumi Abstract:BACKGROUND: Nivolumab, a programmed death-1 antibody, is an immune checkpoint inhibitor approved in Japan in March 2017 for the treatment of recurrent or metastatic head and neck cancers (RM-HNCs) after platinum drug administration. This study aimed to evaluate the effectiveness and safety of nivolumab and to determine the prognostic factors affecting the treatment outcome, in a real-world setting in Japanese RM-HNCs. METHODS: Forty-six patients with RM-HNCs treated with nivolumab between April 2017 and April 2021 at Shinshu University Hospital were retrospectively assessed in this cohort study. RESULTS: The overall response rate was 17.4%, and the disease control rate was 41.3%. The median first and second progression-free survival (PFS1 and PFS2) were 2.6 and 10.3 months, respectively. The median overall survival (OS) was 14.8 months. Multivariate analysis showed that performance status (PS) (p = 0.003) and a decrease in neutrophil-lymphocyte ratio (NLR) (p = 0.02) were significantly associated with a better OS, and a decrease in NLR (p = 0.035) was associated with a better PFS2. CONCLUSIONS: This study is the first report of PFS2 in RM-HNCs treated with nivolumab; the long PFS2 may contribute to prolonged OS. We propose that the PS and a decrease in NLR could be useful clinical prognostic markers of nivolumab therapy, which can easily be evaluated in the clinical setting.
The availability of an adhesive bone conduction hearing device: a preliminary report of a single-center experience. Acta oto-laryngologica,140(4):319-326 2020(Apr.) Author:Hideaki Moteki; Ryosuke Kitoh; Shin-Ichi Usami Abstract:Background: An adhesively attached bone conduction hearing device has been newly developed. This novel bone conduction hearing device is placed behind the ear and has an audio processor connected to the adapter to transmit sound through vibrations.Objective: To obtain preliminary results regarding the use of this device, we sought to apply it to patients with various types of hearing loss.Methods: Nine patients aged over 18 years and with hearing loss due to bilateral middle ear anomaly (n = 1), bilateral aural atresia (n = 3), unilateral aural atresia (n = 2), and single-sided deafness (n = 3) were recruited.Results: The functional gain provided by the adhesive bone conduction hearing device for the aided side was found to be sufficient. Although the results on speech perception in noise showed significant improvement for patients with conductive hearing loss, no improvement was found for patients with single-sided deafness. Subjective assessment showed that speech and spatial hearing-related issues were improved.Conclusion: The adhesive bone conduction hearing device was thought to provide a feasible option. Additionally, in patients considering the use of a surgically implanted hearing device, this device is a preferable option for preoperative assessment due to its non-invasiveness.
Treatment algorithm for idiopathic sudden sensorineural hearing loss based on epidemiologic surveys of a large Japanese cohort. Acta oto-laryngologica,140(1):32-39 2020(Jan.) Author:Ryosuke Kitoh; Shin-Ya Nishio; Shin-Ichi Usami Abstract:Background: To date, there have been few conventional algorithms for the treatment of idiopathic sudden sensorineural hearing loss (SSNHL), as there have been only limited reports with high evidence levels.Objectives: To propose an evidence- and trend-based treatment algorithm for SSNHL.Methods: We referred not only to the evidence for each treatment, but also to trends related to treatment selection in Japan based on epidemiologic surveys, and considered the balance of the advantages and disadvantages with regard to each patient's condition.Results: We propose an algorithm that begins with the grade of SSNHL severity as the prognosis of SSNHL is strongly related to the severity of hearing loss. We selected systemic corticosteroid therapy as the first-line therapy, and Intra-tympanic corticosteroid therapy as salvage therapy. We also proposed the use of prostaglandin E1 with corticosteroids for the treatment of SSNHL patients with severe hearing loss. According to the data obtained from an epidemiologic survey, we decided time limits for the application of each treatment.Conclusion: An algorithm for the treatment for SSNHL is presented according to the results of epidemiologic surveys in Japan. It is expected that this algorithm can provide a guide to choosing the suitable treatment for SSNHL patients.
Differences between acoustic trauma and other types of acute noise-induced hearing loss in terms of treatment and hearing prognosis. Acta oto-laryngologica,137(sup565):S48-S52 2017 Author:Tetsuro Wada; Hajime Sano; Shin-Ya Nishio; Ryosuke Kitoh; Tetsuo Ikezono; Satoshi Iwasaki; Kimitaka Kaga; Atsushi Matsubara; Tatsuo Matsunaga; Takaaki Murata; Yasushi Naito; Mikio Suzuki; Haruo Takahashi; Testuya Tono; Hiroshi Yamashita; Akira Hara; Shin-Ichi Usami Abstract:OBJECTIVES: To evaluate the differences between acoustic trauma (AT) and other types of acute noise-induced hearing loss (ANIHL), we performed a literature search and case reviews. METHODS: The literature search based on online databases was completed in September 2016. Articles on ANIHL and steroid treatment for human subjects were reviewed. The source sounds and treatment sequelae of our accumulated cases were also reviewed. Hearing loss caused by gun-shots and explosions was categorized into the AT group, while hearing loss caused by concerts and other noises was categorized into the ANIHL group. RESULTS: Systemic steroid treatment did not appear to be effective, at least in the AT group, based on both the literature and our case reviews. However, effective recovery after treatment including steroids was observed in the ANIHL group. The difference in hearing recovery between the AT and ANIHL groups was statistically significant (p = .030), although differences in age, days from the onset to treatment and pretreatment hearing levels were not significant. CONCLUSIONS: Hearing recovery from AT is very poor, whereas, ANIHL is recoverable to some extent. Therefore, it is essential to differentiate between these two groups for accurate prediction of the hearing prognosis and evaluation of treatment effects.
Nationwide epidemiological survey of idiopathic sudden sensorineural hearing loss in Japan. Acta oto-laryngologica,137(sup565):S8-S16 2017 Author:Ryosuke Kitoh; Shin-Ya Nishio; Kaoru Ogawa; Sho Kanzaki; Naohito Hato; Michihiko Sone; Satoshi Fukuda; Akira Hara; Tetsuo Ikezono; Kotaro Ishikawa; Satoshi Iwasaki; Kimitaka Kaga; Seiji Kakehata; Atsushi Matsubara; Tatsuo Matsunaga; Takaaki Murata; Yasushi Naito; Takashi Nakagawa; Kazunori Nishizaki; Yoshihiro Noguchi; Hajime Sano; Hiroaki Sato; Mikio Suzuki; Hideo Shojaku; Haruo Takahashi; Hidehiko Takeda; Testuya Tono; Hiroshi Yamashita; Tatsuya Yamasoba; Shin-Ichi Usami Abstract:OBJECTIVES: Using a large-scale nationwide survey database, we investigated the epidemiological characteristics for idiopathic SSNHL in Japan. METHODS: The subjects for this analysis were patients registered in a Japanese multicentre database between April 2014 and March 2016. A total of 3419 idiopathic SSNHL patients were registered in the database, and the clinical characteristics of the idiopathic SSNHL patients were obtained. Several factors associated with the severity of hearing impairment and prognosis were then investigated. Statistical analysis was performed to clarify the factors associated with the severity of hearing impairment and prognosis. RESULTS: There were significant correlations between the severity of hearing loss and diabetes mellitus, kidney disease, past history of brain infarction, heart disease, age (under 16 years/elderly), and symptoms of vertigo/dizziness. We also analyzed the prognostic factors for idiopathic SSNHL, and found that the severity of hearing loss (Grade 3 or 4), heart disease, aged 65 years or over, time from onset to treatment (over 7 days), and symptoms of vertigo/dizziness were all significantly related to poor prognosis. CONCLUSION: The present large-scale clinical survey revealed current epidemiological trends for idiopathic sudden sensorineural hearing loss (SSNHL) and various factors associated with the severity of hearing impairment and prognosis.
A nationwide multicenter study of the Cochlin tomo-protein detection test: clinical characteristics of perilymphatic fistula cases. Acta oto-laryngologica,137(sup565):S53-S59 2017 Author:Han Matsuda; Kei Sakamoto; Tomohiro Matsumura; Shiho Saito; Susumu Shindo; Kunihiro Fukushima; Shin-Ya Nishio; Ryosuke Kitoh; Osamu Shibasaki; Akinori Ito; Ryuichiro Araki; Shin-Ichi Usami; Mamoru Suzuki; Kaoru Ogawa; Tomonori Hasegawa; Yoshiaki Hagiwara; Yasuhiro Kase; Tetsuo Ikezono Abstract:OBJECTIVE: To investigate the positive rate for the Cochlin tomo-protein (CTP: an inner ear-specific protein) detection test among patients with inner ear-related clinical manifestations and evaluate the clinical characteristics of definite perilymphatic fistula (PLF). METHODS: We have performed an ELISA-based CTP detection test using middle ear lavage (MEL) samples from 497 cases of suspected PLF enrolled from 70 clinical centers nationwide between 2014 and 2015. In addition to the CTP-positive rate, audio-vestibular symptoms were compared between CTP-positive and -negative cases. RESULTS: 8-50% of patients in category 1 (trauma, middle and inner ear disease cases), and about 20% of those in categories 2, 3 and 4 (external origin antecedent events, internal origin antecedent events, and without antecedent event, respectively) were positive for CTP. In category 1 cases, the earlier tested samples showed a higher CTP-positive rate, whereas no differences were observed in categories 2, 3 or 4. The characteristic clinical features in the earlier tested cases were nystagmus and fistula sign in CTP test-positive cases in category 1, and streaming water-like tinnitus in those in categories 2, 3 and 4. CONCLUSION: The present study clarified that CTP detection test-positive patients exist at considerable rates among patients with inner ear-related manifestations.
Idiopathic sudden sensorineural hearing loss and acute low-tone sensorineural hearing loss: a comparison of the results of a nationwide epidemiological survey in Japan. Acta oto-laryngologica,137(sup565):S38-S43 2017 Author:Tadao Yoshida; Michihiko Sone; Ryosuke Kitoh; Shin-Ya Nishio; Kaoru Ogawa; Sho Kanzaki; Naohito Hato; Satoshi Fukuda; Akira Hara; Tetsuo Ikezono; Kotaro Ishikawa; Satoshi Iwasaki; Kimitaka Kaga; Seiji Kakehata; Atsushi Matsubara; Tatsuo Matsunaga; Takaaki Murata; Yasushi Naito; Takashi Nakagawa; Kazunori Nishizaki; Yoshihiro Noguchi; Hajime Sano; Hiroaki Sato; Mikio Suzuki; Hideo Shojaku; Haruo Takahashi; Hidehiko Takeda; Testuya Tono; Hiroshi Yamashita; Tatsuya Yamasoba; Shin-Ichi Usami Abstract:OBJECTIVES: The aim of this study was to investigate the differences between idiopathic sudden sensorineural hearing loss (SSNHL), and acute low-tone sensorineural hearing loss (ALHL) using the results of a nationwide survey database in Japan and to analyze the variables associated with their clinical features and the severity of hearing impairment, treatment, and prognosis. METHODS: Participants were patients registered between April 2014 and March 2016 in a multicenter epidemiological survey database involving 30 university hospitals and medical centers across Japan. Statistical analysis was performed to clarify the factors associated with their clinical characteristics and the severity of hearing impairment, treatment, and prognosis. RESULTS: Idiopathic SSNHL and ALHL differed significantly in terms of male-to-female ratio, age distribution, and time from onset to start of treatment. The treatment methods and hearing prognosis also differed markedly between the two diseases. A majority (92%) of idiopathic SSNHL patients were administered some type of corticosteroid, while half of the ALHL patients received corticosteroids and a diuretic agent. CONCLUSION: The results suggested that idiopathic SSNHL and ALHL belonged to different categories of inner ear disease.
Epidemiological survey of acute low-tone sensorineural hearing loss. Acta oto-laryngologica,137(sup565):S34-S37 2017 Author:Hiroaki Sato; Shigeru Kuwashima; Shin-Ya Nishio; Ryosuke Kitoh; Satoshi Fukuda; Akira Hara; Naohito Hato; Tetsuo Ikezono; Kotaro Ishikawa; Satoshi Iwasaki; Kimitaka Kaga; Atsushi Matsubara; Tatsuo Matsunaga; Takaaki Murata; Yasushi Naito; Takashi Nakagawa; Kazunori Nishizaki; Yoshihiro Noguchi; Kaoru Ogawa; Hajime Sano; Michihiko Sone; Hideo Shojaku; Haruo Takahashi; Testuya Tono; Hiroshi Yamashita; Tatsuya Yamasoba; Shin-Ichi Usami Abstract:OBJECTIVES: A nationwide epidemiological survey involving 23 hospitals in Japan was conducted and the predictive values of demographic data were examined statistically. METHODS: A total of 642 patients from 23 hospitals, including 20 university hospitals, in Japan were enrolled in the study. Age ranged from 8 to 87 years, and all were diagnosed with acute low-tone sensorineural hearing loss (ALHL) between 1994 and 2016. Demographic data for the patients, such as symptoms, gender, mean age, and distribution of ALHL grading, were collected and analyzed in relation to prognosis using Student's t-test, χ2 test and logistic regression. RESULTS: Female gender (p < .013), younger age (p < .001), low-grade hearing loss (p < .001), and shorter interval between onset and initial visit (p < .004) were significantly predictive of a good prognosis. The prognosis for definite ALHL was significantly better than that for probable ALHL (p < .007). CONCLUSIONS: The severity of initial hearing loss, interval between onset and initial visit and age were important prognostic indicators for ALHL, while female gender was an important prognostic indicator peculiar to ALHL.
Prognostic impact of gene polymorphisms in patients with idiopathic sudden sensorineural hearing loss. Acta oto-laryngologica,137(sup565):S24-S29 2017 Author:Ryosuke Kitoh; Shin-Ya Nishio; Shin-Ichi Usami Abstract:OBJECTIVE: To investigate whether genetic polymorphisms (single-nucleotide polymorphism [SNPs]) have a prognostic influence on hearing recovery after standardized corticosteroid therapy. METHODS: A total of 192 gene samples from idiopathic sudden sensorineural hearing loss (SSNHL) patients registered in the Intractable Inner Ear Disease Gene Bank were enrolled and, as the candidate genes, 16 SNPs from 13 genes were selected for this study. Fischer's exact test was used to compare allele frequencies in each SNP between the patients with good hearing recovery and patients with poor hearing recovery. RESULTS: The SNPs of the GSR gene (rs2251780 and rs3779647) and NOS3 gene (rs1799983) were associated with treatment outcome (p < .05). Furthermore, there was a marginal correlation between the SNP of the NR3C1 gene (rs4912910) and treatment outcome (p = .05). CONCLUSIONS: The results of this study indicate that the analysis of genetic factors might make it possible to predict the treatment outcome, at least in part, in patients with idiopathic SSNHL.
Etiology of single-sided deafness and asymmetrical hearing loss. Acta oto-laryngologica,137(sup565):S2-S7 2017 Author:Shin-Ichi Usami; Ryosuke Kitoh; Hideaki Moteki; Shin-Ya Nishio; Tomohiro Kitano; Masafumi Kobayashi; Jun Shinagawa; Yoh Yokota; Kenjiro Sugiyama; Kizuki Watanabe Abstract:CONCLUSIONS: The present study revealed that various etiologies are involved in single-sided deafness (SSD), and that the cause of SSD and asymmetrical hearing loss (AHL) differed greatly between congenital/early-onset cases and adult cases. Clarification of the etiology is the first step toward providing appropriate intervention. OBJECTIVES: The study aimed to clarify the etiology of SSD and AHL patients. METHODS: The etiology of a total of 527 SSD or AHL patients who visited Shinshu University Hospital between 2006 and 2016 were analyzed by imaging as well as serological tests for mumps virus, and CMV DNA testing. RESULTS: In our cohort of congenital/early-onset SSD (n = 210), the most prevalent cause in children was cochlear nerve deficiency (43.7%; 87 of 199 patients undergoing CT and/or MRI), followed by CMV infection, mumps infection, anomalies of the inner ear, ANSD, and other rare etiologies. In contrast, half of the adult SSD patients presented with idiopathic sensorineural hearing loss, followed by various types of otitis media, cerebellopontine angle tumor and other rare etiologies.
The effect of initial treatment on hearing prognosis in idiopathic sudden sensorineural hearing loss: a nationwide survey in Japan. Acta oto-laryngologica,137(sup565):S30-S33 2017 Author:Masahiro Okada; Naohito Hato; Shin-Ya Nishio; Ryosuke Kitoh; Kaoru Ogawa; Sho Kanzaki; Michihiko Sone; Satoshi Fukuda; Akira Hara; Tetsuo Ikezono; Kotaro Ishikawa; Satoshi Iwasaki; Kimitaka Kaga; Seiji Kakehata; Atsushi Matsubara; Tatsuo Matsunaga; Takaaki Murata; Yasushi Naito; Takashi Nakagawa; Kazunori Nishizaki; Yoshihiro Noguchi; Hajime Sano; Hiroaki Sato; Mikio Suzuki; Hideo Shojaku; Haruo Takahashi; Hidehiko Takeda; Tetsuya Tono; Hiroshi Yamashita; Tatsuya Yamasoba; Shin-Ichi Usami Abstract:OBJECTIVE: To investigate the hearing prognosis of idiopathic sudden sensorineural hearing loss (SSNHL) treated with different initial therapies. METHODS: Subjects consisted of patients diagnosed with idiopathic SSNHL within 7 days from onset and showing severe hearing loss (≥60 dB), who were registered in a Japanese multicenter database between April 2014 and March 2016. Subjects were divided into four groups according to initial therapy: (1) steroids, (2) steroids + Prostaglandins (PGs), (3) intratympanic steroids (ITS), and (4) no steroids. Hearing outcomes were compared among the groups. RESULTS: In total, 1305 patients were enrolled. The final hearing level and hearing gain of patients treated with steroids + PGs were significantly higher than those of patients treated with steroids alone or no steroids. The ratio of good prognosis (complete recovery or marked improvement) in patients treated with steroids + PGs was higher than that in patients treated with steroids alone or no steroids. There was no difference in the prognosis of patients treated with steroids alone or no steroids. CONCLUSION: A large number of patients with idiopathic SSNHL were registered in a multicenter database. PG use in combination with steroid administration was associated with a good hearing prognosis in patients with severe hearing loss.
The clinical features and prognosis of mumps-associated hearing loss: a retrospective, multi-institutional investigation in Japan. Acta oto-laryngologica,137(sup565):S44-S47 2017 Author:Shinya Morita; Keishi Fujiwara; Atsushi Fukuda; Satoshi Fukuda; Shin-Ya Nishio; Ryosuke Kitoh; Naohito Hato; Tetsuo Ikezono; Kotaro Ishikawa; Kimitaka Kaga; Atsushi Matsubara; Tatsuo Matsunaga; Takaaki Murata; Yasushi Naito; Kazunori Nishizaki; Kaoru Ogawa; Hajime Sano; Hiroaki Sato; Michihiko Sone; Mikio Suzuki; Haruo Takahashi; Tetsuya Tono; Hiroshi Yamashita; Tatsuya Yamasoba; Shin-Ichi Usami Abstract:CONCLUSIONS: The majority of hearing loss due to mumps presents as unilateral profound sensorineural hearing loss, which is refractory to treatment. In rare cases of bilateral total deafness, cochlear implants were beneficial for speech perception. Vaccination against mumps is recommended to prevent mumps-associated hearing loss. OBJECTIVE: The objective of this study is to investigate the clinical characteristics of hearing loss due to mumps and to evaluate hearing outcomes. SUBJECTS AND METHODS: The clinical parameters were analyzed under a retrospective multi-institutional study design in patients diagnosed with hearing loss due to mumps at the Otolaryngology departments of 19 hospitals between 1987 and 2016. RESULTS: Sixty-seven patients with hearing loss due to mumps were enrolled. The study population consisted of 35 males and 32 females, ranging in age from 1 to 54, with a median age of 9.5 years. Sixty-three patients presented with unilateral, and 4 with bilateral hearing loss. Profound hearing loss was observed in 65 ears. Only one ear with severe hearing loss showed complete recovery. Four patients with bilateral hearing loss received cochlear implant surgery. Most of the patients with hearing loss due to mumps had no history of vaccination.
Relationships among drinking and smoking habits, history of diseases, body mass index and idiopathic sudden sensorineural hearing loss in Japanese patients. Acta Otolaryngol,137(sup565):S17-S23 2017 Author:Umesawa M, Kobashi G, Kitoh R, Nishio SY, Ogawa K, Hato N, Sone M, Fukuda S, Hara A, Ikezono T, Ishikawa K, Iwasaki S, Kaga K, Kakehata S, Matsubara A, Matsunaga T, Murata T, Naito Y, Nakagawa T, Nishizaki K, Noguchi Y, Sano H, et al.
Towards a Unified Testing Framework for Single-Sided Deafness Studies: A Consensus Paper. Audiology & neuro-otology,21(6):391-398 2016 Author:Paul Van de Heyning; Dayse Távora-Vieira; Griet Mertens; Vincent Van Rompaey; Gunesh P Rajan; Joachim Müller; John Martin Hempel; Daniel Leander; Daniel Polterauer; Mathieu Marx; Shin-Ichi Usami; Ryosuke Kitoh; Maiko Miyagawa; Hideaki Moteki; Kari Smilsky; Wolf-Dieter Baumgartner; Thomas Georg Keintzel; Georg Mathias Sprinzl; Astrid Wolf-Magele; Susan Arndt; Thomas Wesarg; Stefan Zirn; Uwe Baumann; Tobias Weissgerber; Tobias Rader; Rudolf Hagen; Anja Kurz; Kristen Rak; Robert Stokroos; Erwin George; Ruben Polo; María Del Mar Medina; Yael Henkin; Ohad Hilly; David Ulanovski; Ranjith Rajeswaran; Mohan Kameswaran; Maria Fernanda Di Gregorio; Mario E Zernotti Abstract:BACKGROUND: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL. METHODS: This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada. RESULTS: A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable. CONCLUSION: A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.
SOD1 gene polymorphisms in sudden sensorineural hearing loss. Acta oto-laryngologica,136(5):465-9 2016 Author:Ryosuke Kitoh; Shin-Ya Nishio; Kaoru Ogawa; Makito Okamoto; Ken Kitamura; Kiyofumi Gyo; Hiroaki Sato; Tsutomu Nakashima; Satoshi Fukuda; Kunihiro Fukushima; Akira Hara; Tatsuya Yamasoba; Shin-Ichi Usami Abstract:CONCLUSION: The results suggest that SOD1 rs4998557 could be associated with susceptibility to SSNHL in the Japanese population. OBJECTIVES: To assess the gene association with sudden sensorineural hearing loss (SSNHL). METHODS: A two-stage case control study was conducted to explore the relationship of the candidate genes to SSNHL. The 192 gene samples from SSNHL patients registered in the intractable inner ear disease gene bank were enrolled. As the candidate genes, 39 SNPs from 31 genes were selected for the first stage study. The second stage study examined whether the SOD1 gene polymorphisms, defined by significant differences between cases and controls in the first stage study, are associated with SSNHL. RESULTS: Significant differences were observed in four SNPs from three genes, Glutathione-S-transferase pai 1 (GSTP1), proteine kinase C heta (PRKCH), and superoxide dismutase 1 (SOD1), in terms of allele frequency between SSNHL patients and HapMap controls. In the SOD1 gene, a significant difference was observed in the dominant model study of the SNP rs4998557 in the second stage study. Furthermore, as a result of dividing SSNHL patients based on the clinical data, the difference was more apparent in the case of the over 60 dB group and the tinnitus-positive group.
The effects of cochlear implantation in Japanese single-sided deafness patients: five case reports. Acta oto-laryngologica,136(5):460-4 2016 Author:Ryosuke Kitoh; Hideaki Moteki; Shinya Nishio; Seiichi Shinden; Sho Kanzaki; Satoshi Iwasaki; Kaoru Ogawa; Shin-Ichi Usami Abstract:CONCLUSION: Cochlear implantation (CI) for Japanese single-sided deafness patients resulted in improved speech perception, increased sound localization accuracy, and reduced tinnitus handicap. OBJECTIVES: This study reports results for five adult SSD cases with CI, focusing on the benefits they obtained in terms of speech recognition, sound localization, and tinnitus handicap. METHODS: Five Japanese patients meeting the eligibility criteria were included in this study. All patients were implanted with a fully inserted MED-EL Concerto FLEX28® implant (MED-EL, Innsbruck, Austria). Speech perception outcomes in noise, as well as sound localization and tinnitus disturbance, were assessed pre-surgically and at 1, 3, 6, and 12 months after CI activation. RESULTS: The Japanese monosyllable test score in noise improved gradually after implantation. In some cases, speech perception ability appeared unstable, particularly in the first 1-6 months after implantation. The sound localization ability showed marked improvement in all cases, with the disturbance to daily life caused by tinnitus also decreasing in all cases from the early post-operative period.
Silicone impression material foreign body in the middle ear: Two case reports and literature review. Auris, nasus, larynx,42(5):419-23 2015(Oct.) Author:Nobuyoshi Suzuki; Koji Okamura; Takuya Yano; Hideaki Moteki; Ryosuke Kitoh; Yutaka Takumi; Shin-ichi Usami Abstract:We report two cases of impression material foreign body in the middle ear. The first case had been affected with chronic otitis media. The silicone flowed into the middle ear through a tympanic membrane perforation during the process of making an ear mold. About 4 years and 8 months after, the patient had severe vertigo and deafness. We found bone erosion of the prominence of the lateral semicircular canal and diagnosed labyrinthitis caused by silicone impression material. In the second case silicone flowed into the canal wall down mastoid cavity. Both cases required surgery to remove the foreign body. The clinical courses in such cases are variable and timing of surgery is sometimes difficult. In addition to reporting these two cases, we present here a review of the literature regarding impression material foreign bodies.
[Ototoxicity of cisplatin]. Nihon rinsho. Japanese journal of clinical medicine,73 Suppl 2:480-5 2015(Feb.) Author:Ryosuke Kitoh; Shin-Ichi Usami
The advantages of sound localization and speech perception of bilateral electric acoustic stimulation. Acta oto-laryngologica,135(2):147-53 2015(Feb.) Author:Hideaki Moteki; Ryosuke Kitoh; Keita Tsukada; Satoshi Iwasaki; Shin-Ya Nishio; Shin-Ichi Usami Abstract:CONCLUSION: Bilateral electric acoustic stimulation (EAS) effectively improved speech perception in noise and sound localization in patients with high-frequency hearing loss. OBJECTIVE: To evaluate bilateral EAS efficacy of sound localization detection and speech perception in noise in two cases of high-frequency hearing loss. METHODS: Two female patients, aged 38 and 45 years, respectively, received bilateral EAS sequentially. Pure-tone audiometry was performed preoperatively and postoperatively to evaluate the hearing preservation in the lower frequencies. Speech perception outcomes in quiet and noise and sound localization were assessed with unilateral and bilateral EAS. RESULTS: Residual hearing in the lower frequencies was well preserved after insertion of a FLEX(24) electrode (24 mm) using the round window approach. After bilateral EAS, speech perception improved in quiet and even more so in noise. In addition, the sound localization ability of both cases with bilateral EAS improved remarkably.
Prevalence of level V metastasis in head and neck squamous cell carcinoma. Acta oto-laryngologica,133(2):218-24 2013(Feb.) Author:Kazuyuki Kainuma; Takuya Yano; Ryosuke Kitoh; Takehiko Naito; Shin-ichi Usami Abstract:CONCLUSION: The results of this study accord with those of past reports about the prevalence of level V metastasis in head and neck squamous cell carcinoma (HNSCC) cases. Because of the low rate of level V metastasis, and from the viewpoint of standard postoperative radiotherapy, selective neck dissection without level V dissection may be possible in cases without clinical evidence of level V metastasis on both the ipsilateral and contralateral sides. In addition, degree of pathological differentiation and pN stage >N2b are suggested risk factors for level V metastasis. OBJECTIVES: The most frequent complication of any type of neck dissection in HNSCC cases with level V metastasis is shoulder dysfunction secondary to traction or ischemic injury to the spinal accessory nerve (SAN). The purpose of this study was to examine procedures to preserve the SAN and avoid level V dissection and shoulder dysfunction due to SAN injury. This study investigated the prevalence of level V metastasis and its associated risk factors at various primary sites in patients with HNSCC. METHODS: Clinical and pathological data were retrospectively reviewed for 162 patients with HNSCC, including those with clinically negative neck (cN0) and clinically positive neck (cN+) in whom level V neck dissection was performed. The prevalence of pathological metastasis to level V lymph nodes on both the ipsilateral and contralateral sides was investigated. Several potentially predictive risk factors for level V metastasis, such as age, sex, primary site, T stage, N stage, degree of pathological differentiation, and lymph node status of levels I-IV, were also evaluated. Statistical analysis was performed using Fisher's exact test. RESULTS: In total, 301 neck dissections (ipsilateral side, n = 162; contralateral side, n = 139) were performed in this study. The most common primary site was the oral cavity (n = 51), followed by the larynx (n = 48), hypopharynx (n = 39), and oropharynx (n = 24). On the ipsilateral side, the overall incidence of pathologically positive neck (pN+) was 63.6% (103/162). The overall prevalence of level V metastasis was 7.4% (12/162), 6.8% (11/162) on the ipsilateral side, and 1.4% (2/139) on the contralateral side. Isolated level V metastasis and bilateral level V metastasis was observed in three patients and one patient, respectively. Metastasis to level V and other levels was observed in eight patients (8/96, 8.3%), and level V involvement on the ipsilateral side alone was observed only in three patients (3/66, 4.5%). There were two cases in which level V was involved when the other levels were also involved (2/22, 9.1%), and there was no case in which the other levels were not involved on the contralateral side. A statistically significant association was found between level V metastasis and pN stage >N2b (p = 0.0035), degree of pathological differentiation (p = 0.0305) on the ipsilateral side, status of neck levels I-IV (p = 0.001), and the number of positive neck levels (p < 0.0001) on the contralateral side.
A case of epidermolysis bullosa acquisita associated with laryngeal stenosis. Acta dermato-venereologica,92(1):93-4 2012(Jan.) Author:Yukiko Kiniwa; Atsuko Ashida; Atsuko Ohashi; Ryosuke Kitoh; Shunpei Fukuda; Takashi Hashimoto; Ryuhei Okuyama
The first report of bilateral retropharyngeal lymph node metastasis from papillary thyroid carcinoma and review of the literature. Acta oto-laryngologica,131(12):1341-8 2011(Dec.) Author:Kazuyuki Kainuma; Ryosuke Kitoh; Hidekane Yoshimura; Shin-ichi Usami Abstract:The sites of lymph node metastasis of papillary thyroid carcinomas are typically the paratracheal and jugular lymph nodes. On the other hand, metastasis to the retropharyngeal or parapharyngeal nodes from papillary thyroid carcinomas is very rare. During the last two decades, limited to cases with a histologically definite diagnosis by surgery, only 39 cases have been reported. All reported cases were unilateral retropharyngeal or parapharyngeal node metastasis except one metachronous bilateral case, and there were no reports of simultaneous bilateral cases within our literature review. We report three cases of retropharyngeal node metastasis from thyroid papillary carcinoma, including a case of bilateral nodal metastasis. Retropharyngeal node metastasis was successfully resected in all three patients by the transcervical approach. As pointed out in past reports, this report also suggests that prior neck dissection and/or metastasis to cervical lymph nodes might alter the direction of lymphatic drainage to the retrograde fashion, resulting in the unusual metastasis to the retropharyngeal lymph nodes, and there is a possibility of a bilateral pattern. Also, it is necessary to consider the possibility of metastasis from a papillary thyroid carcinoma in the differential diagnosis of lymph node swelling in the parapharyngeal space.
Different cortical metabolic activation by visual stimuli possibly due to different time courses of hearing loss in patients with GJB2 and SLC26A4 mutations. Acta oto-laryngologica,131(11):1232-6 2011(Nov.) Author:Hideaki Moteki; Yasushi Naito; Keizo Fujiwara; Ryosuke Kitoh; Shin-ya Nishio; Kazuhiro Oguchi; Yutaka Takumi; Shin-ichi Usami Abstract:CONCLUSION: We have demonstrated differences in cortical activation with language-related visual stimuli in patients who were profoundly deafened due to genetic mutations in GJB2 and SLC26A4. The differences in cortical processing patterns between these two cases may have been influenced by the differing clinical courses and pathogenesis of hearing loss due to genetic mutations. Our results suggest the importance of hearing during early childhood for the development of a normal cortical language network. OBJECTIVES: To investigate the cortical activation with language-related visual stimuli in patients who were profoundly deafened due to genetic mutations in GJB2 and SLC26A4. METHODS: The cortical activity of two adult patients with known genetic mutations (GJB2, SLC26A4) was evaluated with fluorodeoxyglucose-positron emission tomography (FDG-PET) with a visual language task and compared with that of normal-hearing controls. RESULTS: A patient with a GJB2 mutation showed activation in the right auditory association area [BA21, BA22], and the left auditory association area [BA42] even with visual language task; in contrast, a patient with an SLC26A4 mutation showed no significant activation in the corresponding area.
Inverted papilloma of the middle ear: a case report and review of the literature. Acta oto-laryngologica,131(2):216-20 2011(Feb.) Author:Kazuyuki Kainuma; Ryosuke Kitoh; Sano Kenji; Shin-Ichi Usami Abstract:Papilloma of the middle ear is extremely rare; to our knowledge there have been only 9 reports (13 cases) in the literature. Aggressive surgical excision is the only curative treatment and radiation therapy is necessary if there is evidence of focal squamous cell carcinoma. We describe a case of a 65-year-old male with inverted papilloma of the middle ear. The tumor was surgically resected by radical tympanomastoidectomy, and we provided postoperative radiation therapy. There has been no evidence of recurrence to date. We discuss the clinical presentation, diagnosis, and treatment of this case and present a review of the literature.
Immunocytochemical localization of ubiquitin A-52 protein in the mouse inner ear. Neuroreport,18(9):869-73 2007(Jun. 11) Author:Ryosuke Kitoh; Aki Oshima; Nobuyoshi Suzuki; Shigenari Hashimoto; Yutaka Takumi; Shin-ichi Usami Abstract:The ubiquitin A-52 residue ribosomal protein fusion product 1 (UbA52) is a gene highly expressed specifically in the inner ear. Through cellular localization we immunocytochemically investigated its function in the inner ear. In the adult mouse, UbA52 protein was distributed in the strial marginal cells and vestibular dark cells, which regulate the endolymphatic ion homeostasis. In the developing mouse cochlea, no significant staining was observed from birth to postnatal day 3, whereas after postnatal day 6, strong UbA52-immunoreactivities were observed in strial marginal cells. Endolymphatic K concentration is elevated between postnatal days 3-8: therefore, our results indicate that UbA52 may have a functional role in regulation of ion secretion in the inner ear.
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