We conducted an observational cross-sectional study of 85 Japanese adult patients examined by our sleep laboratory for Study Objectives: Sleep breathing patterns are altered by nasal obstruction and respiratory events. This study aimed to describe the relationships between specifi c sleep oral fl ow (OF) patterns, nasal airway obstruction, and respiratory events. Methods: Nasal fl ow and OF were measured simultaneously by polysomnography in 85 adults during sleep. OF was measured 2 cm in front of the lips using a pressure sensor. Results: OF could be classifi ed into three patterns: postrespiratory event OF (postevent OF), during-respiratory event OF (during-event OF), and spontaneous arousal-related OF (SpAr-related OF). Postevent OFs begin at the end of airfl ow reduction, are preceded by respiratory arousal, and are accompanied by postapneic hyperventilation; duringevent OFs occur during nasal fl ow reduction; and SpAr-related OFs to OF begin during stable breathing, and are preceded by spontaneous arousal but are rarely accompanied by apnea/hypopnea. Multivariate regression showed that nasal obstruction was predictive of SpAr-related OF. The relative frequency of SpAr-related OF events was negatively correlated with the apnea-hypopnea index. The fraction of SpAr-related OF duration relative to total OF duration was signifi cantly greater in patients with nasal obstruction than in those without. Conclusions: SpAr-related OF was associated with nasal obstruction, but not respiratory events. This pattern thus functions as a "nasal obstruction bypass", mainly in normal subjects and patients with mild sleep disordered breathing (SDB). By contrast, the other two types were related to respiratory events and were typical patterns seen in patients with moderate and severe SDB. 1 showed that oral breathing during sleep is induced by increased nasal resistance. Mouth opening increased upper airway collapsibility during sleep, which is different from that seen when awake.2 Fitzpatrick et al. 3 confi rmed that during sleep, upper airway resistance during oral breathing was 2.5 times higher than that during nasal breathing. Mouth opening may be associated with narrowing of the pharyngeal lumen and decreases in the retroglossal diameter. Mouth opening and oral breathing may, but not necessarily, lead to hypopnea or apnea. However, Lavie et al. 4 showed that nasal obstruction caused a signifi cant increase in the number of arousals during sleep in patients with nonapneic breathing disorders. In another recent study, Hsia et al.5 described a snoring pattern during nasal breathing in patients with nasal obstruction that was alleviated with oral breathing.Against this background, we hypothesized that different kinds of oral fl ow (OF) patterns exist during sleep and are associated with distinct sleep related respiratory events. The BRIEF SUMMARYCurrent Knowledge/Study Rationale: The relationship between oral fl ow (OF) patterns, nasal obstruction, and obstructive respiratory events is unclear. We hypothesized that specifi c O...

Lemierre syndrome (LS) is a rare life-threatening disease that is often caused by an acute oropharyngeal infection with a secondary thrombophlebitis of the internal jugular vein. LS rarely manifests as cranial nerve palsy. To the best of our knowledge, this is the second case report of LS associated with recurrent laryngeal nerve palsy. A 66-year-old female presented to a dental clinic with gingivitis and sore throat. Due to moderate periodontitis, her left first upper molar was extracted. A few days later, she subsequently developed a coarse voice and occipital headaches, and was referred to an otolaryngologist. She was diagnosed with left recurrent laryngeal nerve palsy and subsequent left-sided otitis media, and was referred to us for persistent headaches. She intermittently presented with high-grade fever and complained of salty taste disturbance. Her head magnetic resonance imaging (MRI) revealed left mastoiditis, thrombosis in the left transverse and sigmoid sinus, and left internal jugular vein. Her laboratory tests revealed an elevated white blood cell count, levels of C-reactive protein, and D-dimer. No endogenous coagulopathy was confirmed. Although, blood and cerebrospinal fluid culture grew no microorganisms, respectively, the empirically determined antibiotic therapy was initiated. In a week, the patient defervesced and had no headaches despite persistent thrombosis. Early diagnosis and an immediate antibiotic treatment are crucial for LS patients. Anticoagulation therapy was not needed for our patient and is still controversial for LS.

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The objective of this study is to develop a device for noninvasive local tissue electrical impedance tomography (EIT) using divided electrodes with guard electrodes and to validate its effectiveness using bioequivalent phantoms. For this purpose, we prepared a measurement device and bioequivalent phantoms, measured the electrical characteristics of the phantoms, and validated the method using the phantoms. Monolayer phantoms mimicking the brain and muscle and bilayer phantoms consisting of muscle and brain layers were prepared. The relative differences between the measured electrical conductivities of the monolayer brain and muscle phantoms and the true values determined by the 4-electrode method were both less than 10%. The relative differences between the measured and true values in the bilayer phantoms were less than 20% in both layers. The biological impedance measurement device that we developed was confirmed to be effective for impedance measurement in bilayer phantoms with different electrical impedances. To develop a device for the early diagnosis of breast diseases, the development of a multi-layer phantom and demonstration of the effectiveness of the device for its examination are necessary. If the device that we developed makes impedance measurement in breast tumors possible, it may be used as a new diagnostic modality for breast diseases.

We describe a patient who presented with a frontal sinus osteoma accompanied by a pneumocephalus causing aphasia. A -year old woman with a chief complaint of headache was referred to our outpatient ear, nose, and throat ENT clinic. A CT scan showed a large frontal sinus osteoma and pneumocephalus. Based on the standard language test for aphasia, she presented with aphasia including verbal paraphasia, and difficulty in word finding, reading, and auditory comprehension. She had no agrammatism, or apraxia of speech, and had no difficulties in word fluency or repetition. Kohs block-design test demonstrated that her IQ score was relatively low. After an endoscopic biopsy of her frontal sinus, a craniotomy with resection of the osteoma was performed. Her postoperative CT scan showed a remarkable reduction in the size of the pneumocephalus, and her linguistic and intelligence evaluation showed complete recovery. Her frontal sinus osteoma and linguistic and intelligent function have remained in the normal range for the last years. It is possible that transient aphasia due to pressure and ischemia might have occurred in the center of the orbital pars of the left inferior frontal gyrus, and in the networks between the cortical regions of language function. This is the first case report describing a frontal sinus osteoma accompanied by a pneumocephalus resulting in aphasia without other neurological symptoms.

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The application of hydrostatic positive pressure caused a decrease in pHe and EP. Positive perilymphatic pressure caused the endolymph to become acidic pressure-dependently. Application of 3.0% SNP evoked an increase in both the pHe and pHv, following by a gradual recovery to baseline levels. On the other hand, 0.5% bupivacaine caused a decrease in both the pHe and pHv. The EP during topical application showed slight, non-significant changes.