Generally, the statiscal study is necessary to the analysis of the etiology of the disease. We reported the diseases with the sexual differences of the prevalance rate. At first, we reported the diseases with the sexual differences in some text-books.-a) the cancers at the oral cavity, tongue, pharynx, maxillary sinus and larynx b) the papilloma and malignant lymphoma of the nasopharyx c) Ménière's disease d) the nasal bleedings e) the atrophic rhinitis f) Wegener's granulomatosis g) the otoscrelosis and the paraganglioma of the middle ear. Secondarily, we reported the established date of the department of ENT surgery of Kitazato universty.-a) the Acute Otitis Media b) Otitis media with the effusion c) the acute supprative tonsillitis d) the numbers of the outcomes of chronic supprative Otitis Media e) chronic sinusitis f) the numbers of the out comes of the allergic rhinitis g) the changes of the hearing acuity depending upon the ages. Thirdly, we reported the non-established date of our hospital.-a) the sex and ages of the esophageal foreign body b) the ages of the bronchial foreign body c) the sex and ages of the peritonsillal abscess d) the sex and ages of the infections mononucleosis. At last, we disccussed about the sexual difference of the microscopic findings of the membrane of the maxillary sinusitis, then we emphasized the necessity of the study of the sexual difference of the tissues responsibility to the inflammation.
The nasal manifestation of allergy on the muscosal surface is triggered by a number of mechanisms in different steps Therefore, the treatment should be understood on the basis of knowledge of the following steps; elution of antigenic substance from antigenic particles is inhibited by decreased hypersecretion (cholinergicblockade); interaction of antigenic substance with the surface basophilic cells is suppressed by decreased migration of these cells to the mucosal surface (topical steroid or immunotherapy) and is slightly affected by increased blocking antibody in the mucous layer (immunotherapy); mediator release from the surface basophilic cells is inhibited by a changed enzymic process or by a decrease in the production of the mediator in the cells (mast cell stabilizing agents, immunotherapy); allergic nasal tissue reaction may be suppressed slightly by quick binding of released histamine with protein (histamine-gammaglobulim compound) or is done by decreased nasal sensitivity to histamine (H1 blockad, sedative, Asthremedine, α-stimulant, and cholinergic blockade).
The Heimlich maneuver introduced in 1974 was evaluated to be a most important addition to the first aid procedures for the food choking person. However, the proper position of the maneuver among the procedures previously employed is not determined because Heimlich strongly denounces any use of other procedures. The controversy regarding this problem is reviewed from the literature.
The author had developed a new analytic method of voice, using a microcomputer, which can show speaking fundamental frequency, speaking range and type of speaking. In this report the analysis of 300 cases with laryngeal disease was performed by this new method, both pre-and postoperatively. The type of speaking presented this time was classified into following 4 types,-mountain type, two peaks type, one peak type and pole type. There are good agreement between the results of measurement of speaking fundamental frequency using a new computer method and the results of mesurement of that using acoustic psychological method. There are no remarkable change either in the patients with vocal cord polyp or laryngeal nodule following operation.
Congratulation to the 10th anniversary of Professor Soda Carcinoma of the larynx can be often treated successfully. For example, the five-year cumulative survival rate in Kurume University Hospital was 69.4 percent in 1971-80. The cause of death was intercurrent diseases in 54 percent of the dead. In this period, however, 54.5 percent of the patients with carcinoma of the larynx underwent total laryngectomy. Total laryngectomy is a cripple-producing surgery as well as a life-saving surgery. Any speech following total laryngectomy is inferior to that following any conservation treatments. It is, therefore, our dream to eliminate total laryngectomy in treating carcinoma of the larynx. This is, of course, not an easy task, but, it is not totally unrealistic. This paper describes our current efforts toward the dream. We examined 58 surgical specimens macroscopically and assessed that total laryngectomy could have been avoided ine48 of the 58 patients. A histological investigation of thse specimens is now on-going. Promising alternatives for total laryngectomy are varying combinations of radiotherapy or chemoradiotherapy such as FAR, intensive chemotherapy including cisplatin, laser and partial laryngectomy. Since 1982, we have been carefully applying conservation treatments in selected clinical cases which had been candidates for total laryngectomy. Six of those cases were presented.
Fiberoptic instrument is so useful that many endoscopists are using it in daily practice quite often. The fiberoptic instrument has great advantage over the others because of its flexibility, clear image, easy handling and produces much less discomfort. The instruments, procedures, photographies and movies are presented. There are numerous instruments specifically designed for each purpose. The fiberoptic scope causes essentially no trauma or damage to the tissue to be examined. Other procedures such as biopsies of the tissue, removal of foreign bodies of the airways, aspiration of impacted mucus from tracheobronchial trees and YAG-Nd LASER treatment for malignant lesions are satisfactorily performed.
The intracellular potentials of the cells in the stria vascularis were precisely recorded using cell marking technique. The intracellar potentials of marginal cell, intermediate cell and border cell are +79.8±5.2mV, +32.1±9.7mV and+9.7±5.8mV respectively. The spacial distributions of dc potential and potassium ion in the stria vascularis were also surveyed with double barrel potassium sensitive electrode. A large and a relatively small electrochemical gradients were found on the intermediate cell-side and the endolymphside of cell membranes of marginal cell respectively, which imply the locations of potassium pumps in the stria vascularis.
Anterior tympanotomy is proposed as a new surgical procedure to enlarge the anterior tympanic isthmus in order to prevent the retraction pocket which is common after attic cholesteatoma operation with closed method. The tympanic isthmus is a narrow passage between the meso and epitympanum surrounded with the ossicular chain, facial canal, the tensor tympani tendon and the facial recess. The tympanic isthmus is divided into anterior and posterior by the stapes and the long crus of the incus. In attic cholesteatoma, the tympanic isthmus is closed completely by retraction of the ear drum, fibrous hyperplasia of the mucosal tympnic fold and suppressed pneumatization, although the eustachian tube maintains its patency. If attic cholestetoma is operated with closed technique without enlargement of the stenotic isthmus, recurrence of cholesteatoma following the pocket formation is inevitable. To enlarge and maintain the anterior tympanic isthmus patency, the tensor tympani fold should be removed and the bony ledge should be drilled out with a diamond burr until the tympanic ostium of eustachian tube commanicates directly and widely with the epi tympanic cavity. This surgical procedure is named the anterir tympanotomy.
Of 48 children with functional hearing loss observed in the author's clinic during the 9 years period from 1975 to 1983, 5 attractive cases were demonstrated. Although the diagnosis of non-organic hearing loss can be easily performed using the kinds of modern types of hearing tests, for example, the auditory brainstem response audiometry, it is not easy to get a suspission of functional origin on certain case of under observation. In this viewpoint, the process of diagnosis were demonstrated in these 5 cases. Treatment was also discussed additionally.
Today there are various methods for the fitting of hearing aid. In our institute, an ambulant service section was placed 10 years ago exclusively for patients who need hearing aid. At present, we select a hearing aid mainly according to the standardized selecting method includes the diagnosis of hearing impairment, selection of hearing aids, examination of fitness, lending service of hearing aids and periodic examination of hearing and hearing aids,.
Over the past 7 years we observed ocular reflexes produced tilting stimulation with a subject sitting in an orthocephalic posture on a chair apparatus with a continuous tilt. The vector acceleration separate from the gravity force gives a stimulus to the two otolithic organs, while the tilt apparatus moves slowly. At that point vector acceleration upon each maculas changes continuously. We made use of a tilt chair apparatus which was electrically driven as far as 25 degrees at a speed of 1 degree per seccnd. Eye movement was observed using a nystagmograph and through an infrared TV-camera in front of the eyes. Even in healthy persons nystagmoid eye movement (weak nystagmus) is observed, though only slightly, and patients with vertigo clearly develop nystagmus. Thus, this eye movement can be used as an index for the study. One hundred and seventy patients who complained of vertigo or dizziness were examined by means of our new method. Classification of the nystagmus response is as follows: Type I is of fixed direction, Type II is of changed direction and Type III is a combination of the two. Most healthy persons show no clear nystagmus. Patients with Meniere's disease, sudden deafness and vestibular neuronitis show direction-fixed nystagmus (Type I). In patients with otolithic disorders such as positional vertigo of benign paroxysmal type, when their head and limbs were tilted to the right the nystagmus beat to the left. Similary, when the head was tilted to the left the nystagmus was directed to the opposite side (Type II). Healthy persons were studied by dividing them into three groups by age, namely 20-35 years old (A group), 36-55 years old (B), and over 56 years old (C). Each group consisted of 20 persons or more. Two of the 24 in the A group showed nystagmoid eye movement at a minor amplitude and a small beat number. The incidence of eye movements was minimal but it tended to increase by age, which is considered to be due to geriatric degeneration of static organs including the otolithic organ. In the future in addition to basic study to endorse these findings, study should be made of whether this tilting stimulation is really related to the otolithic organ only, and whether there is any influence on the semicircular canals and the proprioceptive receptor system as well as on the control of the central nervous systems.
In 25 patients with confirmed acoustic and cerebellopontine angle tumours seen in our clinic from 1979 to 1983, the auditory brainstem responses (ABR) were evaluated in relation to the ABR patterns stimulated on affected and non affected ears by means of click sounds. The results are as follows; 1) The ABR patterns obtained from the affected ear stimulation could be separated into 3 types. Type A showed a prolongation of the I-II inter peak latency (IPL) or I-V IPL. Type B showed the presence of wave I only or waves I and II. Type C showed no response. 2) The ABR patterns obtained from non tumour ear stimulation could be separated into 3 types. Type 1 showed the normal range of I-V IPL. Type 2 showed a prolongation of III-V IPL. Type 3, the wave V was still poorly defined or wave V was absent. The abnormalities were observed in 67% of the subjects. 3) The size of tumours in types 2 and 3 were larger than 3cm. as measured on the CT scans. The different ABR components in the affected ear, as compared with findings in the non affected ear provide pertinent information which leads to an early diagnosis of acoustic and cerebellopontine angle tumours. The relationship between the size and location of tumour can also be defined.