Kojiro Tsuji

Hyogo College of Medicine, Nishinomiya, Hyōgo, Japan

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Publications (11)7.48 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To retrospectively evaluate the efficacy of mastoidectomy on methicillin-resistant Staphylococcus aureus (MRSA)-infected chronic otitis media in comparison with methicillin-susceptible Staphylococcus aureus (MSSA)-infected otitis media. Between January 1998 and October 2003, 18 ears underwent surgery for MRSA-infected chronic otitis media with tympanic membrane perforation at the Department of Otolaryngology, Hyogo College of Medicine. Another 33 ears underwent surgery for MSSA-infected chronic otitis media with tympanic membrane perforation during the same period. The postoperative results of graft success rate, hearing results and other complications were compared between MRSA-infected and MSSA-infected ears with or without mastoidectomy, and discharging or dry ears. In MRSA, the mastoidectomy group tended to have a better graft success rate than the non-mastoidectomy group. In MSSA, there were almost the same graft success rate and hearing results between the mastoidectomy and non-mastoidectomy groups regardless of the presence of discharge. In MRSA-infected discharging ears, the rate of postoperative complications (ear drum perforation, persistent otorrhea, and dehiscence of skin incision) were significantly lower in the mastoidectomy group than in the non-mastoidectomy group (p=0.046). Mastoidectomy had significantly better results concerning postoperative complications in discharging ears with MRSA-infected chronic otitis media. We recommend performing tympanoplasty with mastoidectomy in MRSA-infected chronic otitis media.
    Auris Nasus Larynx 04/2007; 34(1):9-13. DOI:10.1016/j.anl.2006.05.017 · 1.14 Impact Factor
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    ABSTRACT: To evaluate the results of bilateral same-day surgery for bilateral perforated chronic otitis media in comparison with our previous report. Prospective study. Seventeen patients ranging in age from 5 to 70 years (mean, 52.5 yr), with bilateral perforated chronic otitis media. Two hundred cases of chronic otitis media were operated on at the Department of Otolaryngology, Hyogo College of Medicine from December 1998 to November 2002. Fifty-nine patients (29.5%) had bilateral disease and 17 patients (8.5%) underwent bilateral same-day surgery. The postoperative air-bone gap was less than 10 dB on both sides in 5 of 17 (29%) and less than 20 dB in 15 of 17 (88%). The postoperative hearing level was less than 20 dB in both ears in 4 of 17 (24%), less than 30 dB in 7 of 17 (41%), and less than 40 dB in 10 of 17 (59%). The rate of closure of the ear drum was 20 of 22 (91%) in the simple underlay myringoplasty series and 9 of 12 (75%) in the conventional myringoplasty/tympanoplasty series. The rate of closure of the ear drum on both sides was successful in 4 of 5 (80%) that underwent simple underlay myringoplasty/simple underlay myringoplasty and 8 of 12 (67%) that underwent simple underlay myringoplasty/conventional myringoplasty/tympanoplasty, whereas that on at least one side was successful in 100%. Bilateral same-day surgery for bilateral perforated chronic otitis media is possible if operative indications are considered. Furthermore, it will help patients save time and money.
    Ontology & Neurotology 10/2005; 26(5):842-5. DOI:10.1097/01.mao.0000185059.66715.e6 · 1.79 Impact Factor
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    ABSTRACT: It is generally said that taste function deteriorates naturally with age. Taste function after middle ear surgery in elderly patients has not been clarified. The taste function of the chorda tympani nerve on the normal and diseased sides was examined before and after middle ear surgery using electrogustometry in 79 patients aged>60 years, and the findings were compared with those in 228 young and middle-aged patients. The threshold of electrogustometry on the normal side increased significantly with increasing age (p<0.0001). The rate of thresholds that were off the scale was highest in the>70 years age group. The preoperative threshold on the diseased side increased significantly with increasing age in patients with chronic otitis media (p=0.0029) and cholesteatoma (p<0.0001). In patients with chronic otitis media, the postoperative threshold of the>60 years age group tended to be higher than that of the<60 years age group. These findings suggest that the taste function of the chorda tympani nerve deteriorated on the diseased side as much as on the normal side in elderly patients. Therefore, in most cases, we do not have to pay as much attention to the chorda tymapani nerve when performing surgery in elderly patients compared to young and middle-aged patients.
    Acta oto-laryngologica. Supplementum 08/2004; 124(553):113-6. DOI:10.1080/03655230410017797
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    ABSTRACT: The management of only hearing ears remains controversial because of the risk of postoperative hearing deterioration. We reviewed 12 cases of hearing ears alone operated on at the Hyogo College of Medicine Department of Otolaryngology from 1999 to 2002. All ears were dry at the final examination. Postoperative hearing results were evaluated based on the guideline of the Japan Otological Society (2000). An air bone gap within 15 dB was found in 9 cases (75%), hearing gain exceeding 15 dB was found in 6 cases (50%), the hearing level was within 30 dB in 4 cases (33.3%), and total successful cases numbered 10 (83.3%). Eight patients wore hearing aids before surgery, and 4 patients (50%) did not need them after the surgery. We suggest that tympanoplasty by skillful surgeons should be done to obtain a dry ear, to avoid a progressive hearing loss, to preserve or improve hearing, and to improve the quality of life. We also suggest that handling of ossicles should minimized in chronic otitis media and cholesteatoma.
    Nippon Jibiinkoka Gakkai Kaiho 02/2004; 107(1):12-7.
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    ABSTRACT: A case of bilateral total deafness after mumps infection is reported. A five-year-old boy complained of bilateral deafness after the onset of bilateral parotid swelling. Audiogram showed profound bilateral hearing loss at all frequencies. We diagnosed labyrinthisis due to mumps virus. High dose of steroid was administered, but hearing did not recover. Thereafter, he was fitted with a hearing aid, but it provided insufficient assistance. He underwent cochlear implant surgery of the left ear, and he recovered hearing up to 40 dB. He is now studying in elementary school. We review seven patients (eight ears) with mumps induced hearing loss treated at Hyogo College of Medicine between April 1997 and March 2002. Six patients demonstrated unilateral loss, but one patient demonstrated bilateral loss. The hearing levels in the five patients were scaled out at the initial examination. The antibody for mumps, IgM and IgG, both showed a high titer in six cases. High dose of steroid was administered in six cases, but none of them recovered hearing. When bilateral deafness due to mumps infection occurs and steroid therapy is not effective, cochlear implant surgery to recover hearing is recommended.
    01/2004; 97(3):197-200. DOI:10.5631/jibirin.97.197
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    ABSTRACT: To study the recovery of function of the chorda tympani nerve, we examined by electrogustometry 79 patients (83 ears) with both preoperative normal function of the nerve and operative preservation of the nerve, every 2 days during hospitalization and at 6 months after surgery. For symptoms such as tongue numbness and taste disturbance, patients with noninflammmatory (NI) diseases (13/20 or 65.0%) showed a significantly higher rate of symptoms than did patients with chronic otitis media (COM; 13/35 or 37.1%) at 2 weeks after surgery (p = .032). The patients with NI diseases (5/20 or 25.0%) tended to show a higher rate of symptoms than did the COM patients (2/35 or 5.7%) or cholesteatoma patients (2/28 or 7.1%) at 6 months after surgery. The rate of recovery of the EGM threshold to normal at 2 weeks after surgery was significantly lower in NI disease patients (6/20 or 30.0%) than in COM patients (23/ 35 or 62.9%) or cholesteatoma patients (19/28 or 67.9%; p = .015 and .008, respectively). Thus, the patients with NI diseases had postoperative symptoms and elevation of EGM threshold more frequently than did the patients with inflammatory diseases.
    The Annals of otology, rhinology, and laryngology 02/2003; 112(1):52-6. DOI:10.1177/000348940311200111 · 1.09 Impact Factor

  • 01/2003; 96(9):811-817. DOI:10.5631/jibirin.96.811
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    ABSTRACT: Force injuries of the soft and hard palates often occur in children, who tend to hold pointed objects in the mouth. In most cases, the injury is superficial and heals uneventfully. However, there have been several cases in which the object penetrated deeply into the epipharynx and had to be removed surgically. In this paper, a chopstick as an epipharyngeal foreign body in an infant is presented. A 2-year-old infant was referred to our clinic due to oral bleeding caused by a chopstick. There was no apparent piece of the chopstick visible. However, CT and MRI demonstrated the remaining chopstick in the soft palate through epipharynx, and flexible fiberscopic examination demonstrated a further piece of chopstick in the epipharynx. It was removed under general anesthesia and he recovered without complications. In the case of infants, it is difficult to determine the site of pain, personal condition and situation of the accident. Determination of residual foreign body is thought to be difficult with only a quick inspection of the wound. Physicians must conduct a proper inspection quickly and take precautions, especially when the foreign body is not found. Imaging study (CT, MRI) was useful in this case of a foreign body involving a chopstick.
    01/2003; 96(12):1081-1086. DOI:10.5631/jibirin.96.1081
  • Kojiro Tsuji · Mieko Sone · Masao Kakibuchi · Masafumi Sakagami ·
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    ABSTRACT: To examine the clinical findings of acquired bilateral cholesteatoma with special reference to incidence of habitual sniffing and sniff-related negative middle ear pressure. Eighty-eight fresh cases of unilateral cholesteatoma and 33 fresh cases of bilateral cholesteatoma, which were operated on at Department of Otolaryngology, Hyogo College of Medicine, were examined in this study. Responses to a detailed questionnaire were obtained from the patients concerning about the habit of habitual sniffing to relieve aural symptoms such as aural fullness, autophonia or hyperacusis. The same questionnaire was obtained from unilateral cholesteatoma patients to compare the incidence of habitual sniffing with that of patients with bilateral cholesteatoma. We measured the negative middle ear pressure at the time of sniffing by using TTAG (tubo-tympano aerodynamic graphy, Nagashima Co. Ltd, Tokyo). We also compared the positive percentage of the sniff test in bilateral cholesteatoma with in unilateral cholesteatoma and normal controls. Sniff test was performed in 30 patients with bilateral cholesteatoma, 20 patients with unilateral cholesteatoma and 20 normal controls. In 33 patients with bilateral cholesteatoma (66 ears), 57 ears had the pars flaccida type (86.4%) and 9 ears had the pars tensa type (13.6%). Cholesteatoma of pars flaccida type were predominant in bilateral cholesteatoma. The rate of habitual sniffing of bilateral cholesteatoma (23/33, 69.7%) was significantly higher than that of unilateral cholesteatoma (21/88, 23.9%). The incidence of positive sniff test in bilateral cholesteatoma (19/30, 63.3%) was significantly higher than in unilateral one (6/20, 30%) and normal control (3/20, 15%). Habitual sniffing was closely related to the pathogenesis of bilateral cholesteatoma, especially in cases with bilateral pars flaccida type.
    Auris Nasus Larynx 05/2002; 29(2):111-4. DOI:10.1016/S0385-8146(01)00146-8 · 1.14 Impact Factor
  • Mieko Sone · Masafumi Sakagami · Kojiro Tsuji · Yasuo Mishiro ·
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    ABSTRACT: Although the chorda tympani nerve (CTN) is frequently damaged during tympanoplasty, little attention has been given to the patients' symptoms and taste function. To investigate patients' symptoms and the functional recovery of taste after surgery using electrogustometry (EGM). Prospective study. Analysis of 163 ears of 156 patients who underwent middle ear surgery from April 1997 through December 1999. There were 18 ears with noninflammatory diseases, 80 with chronic otitis media, and 65 with cholesteatoma. The patients' taste functions were examined 2 days before surgery and 2 weeks and 6 months after surgery. The taste disturbance before and after middle ear surgery and the relationship between age and the recovery rate of CTN function. Two weeks after surgery, the mean EGM threshold was elevated in all groups regardless of preservation or section of the CTN. Numbness in the tongue and taste disturbance were more frequently found in patients with preservation of CTN than in those with section of the CTN (P =.008 and P =.001, respectively). In patients with preservation of the CTN, 6 months after surgery, the recovery rate of EGM threshold was 83% in those aged 20 years or younger (P =.008 compared with the 2 older groups), 53% in the those aged 21 to 40 years, and 44% in those aged 41 to 60 years. Age is an important factor for recovery of taste function after middle ear surgery, which is useful information when explaining complications to patients.
    Archives of Otolaryngology - Head and Neck Surgery 09/2001; 127(8):967-9. DOI:10.1001/archotol.127.8.967 · 2.33 Impact Factor
  • Kojiro Tsuji · Mieko Sone · Masafumi Sakagami ·
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    ABSTRACT: We report a case of cerebellar abscess and sigmoid sinus thrombophlebitis secondary to middle ear cholesteatoma. A 77-year-old female was referred to our clinic with right otorrhea, earache, headache, fever and gate disturbance. CT revealed bony destruction in the posterior fossa of the temporal bone and a cerebellar abscess in the right cerebellum. Emergency abscess drainage via a posterior fossa approach was performed by neurosurgeons, followed by total removal of the cholesteatoma 47 days later. Eight months after the surgery, she recovered her previous mental and physical level and showed no complications. The mortality of intracranial complications such as cerebellar abscess, brain abscess, meningitis and sigmoid sinus thrombosis has decreased recently due to the availability of the preantibiotic treatment. However, typical symptoms are often masked by proceeding antibiotic therapy and it is important to reduce mortality from otogenic complications by early diagnosis and precise treatment in the early stage.
    01/2001; 94(5):405-410. DOI:10.5631/jibirin.94.405