A clinical study of 133 cases with traumatic perforation of the eardrum was performed. These perforations were treated at our clinic between January 1978 and December 1987. The following conclusions were obtained: 1) The vast majority of the cases resulted from direct injury ocurring during ear wax removal. The cases of indirect injury were due to a slap on the auricle. 2) The vast majority of the cases occuring in patients under 10 years were caused by an ear pick or applicator. But in teenagers the injured were primarily a result of hand blow or bruise. 3) The direct injury with ear pick or applicator was more common in females. However, the indirect injury with hand blow or bruise had the same incidence in both sexes. 4) The chief complaints were hearing impairment, otalgia, bleeding, tinnitus and a sensation of ear fullness. 5) Hearing acuity was better in the cases of a small perforation. 6) Complications occured in 14% of cases. They included infection, loss of taste, ossicular dislocation and depression of the stapes footplate. 7) The smaller perforations healed spontaneously in the shortest period of time. But closure of larger perforations needed more time, however, their terms were almost the same. The rate of spontaneous healing was worse in the cases of a large perforation. 8) In almost cases, spontaneous closure can be expected. However after 3 months it can no longer be expected and surgical repair should be performed.

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A 51 year old male who presented with complaints of swelling in the right parotid region and right facial weakness, consulted our hospital in March 1985. He was status post left total nephrectomy for renal cell carcinoma and a right parotidectomy was performed on May 21, 1985. The histological diagnosis was renal cell carcinoma (clear cell type). We report on this case and discuss metastasis of renal cell carcinoma to the head and neck region, especially to the parotid gland.

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A 43 year old female was admitted suffering from nasal bleeding. A tumor was found to be filling the right nasal cavity. CT and MRI examination showed a mass lesion of about 2.5 cm in the upper right nasal cavity but the paranasal sinuses were intact. By lateral rhinotomy the tumor proved to originate from the nasal septum near the olfactory mucous membrane and was completely removed. Histological examination revealed a benign fibrous histiocytoma. There is no evidence of recurrence in 3 years of follow-up. This is the first reported case in Japan of a benign fibrous histiocytoma originating from the nasal septum.

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The purpose of this paper is to analize the various factors influencing the prognosis of laryngeal cancers, especially in cases of mortality within 6 months of initial therapy. A total of twenty-six cases of early mortality are analyzed representing 5.5% of all laryngeal cancer cases, and 11.5% of all cases of mortality from head and neck tumors in our clinic. By anatomical site, 17 cases were supraglottic in location, 8 cases were glottic and 1 case was subglottic. As to TNM clinical classification, 61.5% and 15.4% were judged to be T3 and T4, respectively. An emergency tracheostomie was performed in 8 cases. The authors also analyzed the clinical findings and physical care of early mortality from laryngeal cancer. In order to decrease the rate of early mortality in cancer cases, we must keep in mind the importance of an educational movement in cancer, early diagnosis and treatment by group examination, completeness of initial treatment, severe management and medical care for preand post-treatment.

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A case of a 36 year old female with a cervico-mediastinal thymic cyst is presented. The cyst measured 5×4×3.5cmand was filled with transparent serous fluid. Histologically the cyst was characterized by a thick hyalinized cyst wall beneath a thin layer of epithelial cells, fat tissue and thymic tissue containing Hassall's corpuscles. Before surgery ultrasonography as well as computed tomography were useful for determining the extent of the cyst and providing a differential diagnosis.

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Sino-bronchitis is defined as a coexisting chronic sinusitis and nonspecific chronic inflammatory lesion of the lower airway. We treated 26 children suffering from sino-bronchitis during the past three years. The treatment performed was mainly by means of maxillary antral irrigation through the middle nasal meatus. At the same time antibiotics, enzyme preparations, antitussives and expectorants were administered. As a result, clinical features of sino-bronchitis in childhood as compared to those in adulthood were summarized as follows: 1) Bronchial symptoms (sputum production and cough) were significantly improved after maxillary antral irrigation several times once a week or twice a month. Bronchial symptoms disappeared earlier than nasal symptoms. 2) Sinusitis was chiefly of a localized infectious type. The irrigating water drew out mainly a mass of yellowish pus (sometimes a mass of caseous pus). 3) In adult cases, maxillary antral irrigation did not have as great an effect on bronchial symptoms as it did in children, because the pathological changes were predominantly irreversible in adulthood.

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Bacterial analysis of the otorrhea from chronic otitis media including antibiotic sensitivity was carried out on 214 cases from 1984 to 1987 by use of the Abbott Avantage System. The results are summarized as follows: 1) P. aeruginosa (25%) and S. aureus (18%) were the primary isolates throughout the 4 years. 2) During the 4 years, Genus proteus has gradually decreased. On the other hand, Corynebacterium and S. epidermis increased. 3) P. aeruginosa and Corynebacterium showed high frequency as mixed infections. 4) The sensitivity to various antibiotics of P. aeruginosa and S. aureus were generally low, which reflects their high tolerance. It was proved that OFLX was susceptible.

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When indigocarmine was injected into the tissues surrounding head and neck tumors, the healthy surrounding tissue was stained blue and the carcinomatous region remained unstained. Under histological examination of the specimens, dye was found between collagen bundles and in the lymphatic vessels. Dye was not found in the tumor and parenchematous tissue such as glands. It is suggested that the injection of dye in the surrounding tissue may help in the identification of tumor margins and contribute to the safe resection of the tumor.

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Of 226 patients treated for sudden hearing loss at Jichi Medical School Hospital between 1978 and 1988, four (1.8%) were later diagnosed as acoustic neuroma by roentgenographic examinations. They all displayed moderate to severe hearing loss by audiometry at the onset of sudden deafness. However, two patients recovered almost completely with steroid therapy, while two showed no improvement with this therapy. The acoustic neuromas were removed via translabyrinthine or suboccipital approach. This study supports the rationale that patients with unilateral sudden hearing loss, even with recovery, must be evaluated for a possible cerebellopontine lesion.

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The metabolic disposition of Ofloxacin after intratympanic administration in the guinea pig was studied and was compared with that after oral administration. In the present study, it was clarified that the brain concentrations of Ofloxacin after intratympanic administration were 5 to 10-fold less than serum concentrations. Moreover, almost the same results were observed in the brain and serum concentrations after oral administration. These results indicated that administered Ofloxacin was absorbed mainly from the microvessels in the middle ear and then distributed to the brain and other tissues. Autoradiographic findings also revealed that there was no direct transfer of Ofloxacin into the brain after intratympanic administration. Ofloxacin administered in the middle ear cavity was absorbed completely and was excreted mainly in the urine as the unchanged form and no accumulation was found in the serum after consecutive intratympanic administration for seven days. From these findings, we concluded that there were no differences in the metabolism and disposition between intratympanic and oral administration of Ofloxacin. Because the dose used in otic solution is much lower than that used in oral therapy, it was suggested that incidence of central nervous system side effects resulting from intratympanic Ofloxacin would be lower than that of oral Ofloxacin.

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For objective evaluation of the clinical efficacy, safety and usefulness of Ceftazidime (CAZ) in the treatment of acute suppurative otitis media or acute exacerbation of chronic suppurative otitis media, a comparative study was carried out using Cefotiam (CTM) as the comparator. Patients were given an intravenous bolus injection of either CAZ or CTM lg bid, for 7 consecutive days in principle. 1. In the evaluation of overall clinical effectiveness, efficacy rates by the assessment of doctors in charge in the CAZ group and the CTM group were 73.6% (64/87) and 62.9% (56/89), respectively, and those by the Efficacy Assessment Committee's assessment were 66.7% (58/87) and 61.8% (55/89), respectively. Neither of these assessments showed a statistically significant difference between the two treatment groups. Also, when the clinical effectiveness was assessed for each background factor of the patients, there was no significant difference between the two groups. 2. There was no significant difference between the two treatment groups in any of the categories of overall improvement, improvement in subjective symptoms, or that of objective findings, all assessed on the 3rd and 7th day of administration. 3. Bacteriologically, in the total cases and in the cases suffering from acute exacerbation of chronic suppurative otitis media, bacteriological response of CAZ was significantly superior to that of CTM. Also, complete bacterial elimination rate (excluding ‘ Replaced ’) was significantly higher in the CAZ group than in the CTM group. In elimination rates (if ‘ Replaced ’ cases ware included), no statistically significant difference was noted. When assessed for each type of infection, CAZ showed significantly better bacteriological response in monomicrobial infections caused by Gram-positive and Gram-negative organisms. Also in monomicrobial infections by Cram-positive ogranisms, the rate of ‘Eliminated’ for CAZ was statistically higher than that of CTM. 4. In overall safety, no significant difference was observed between the two groups. Adverse events occurred in 4 cases out of 90 (4.3%) in the CAZ group and in 2 cases out of 92 (2.1%) in the CTM group. As for abnormal laboratory findings, 7 abnormal values were noted in the CAZ group, and 5 were noted in the CTM group. There was no statistically significant difference between the two groups in the incidences of adverse events or laboratory findings. 5. The rates of clinical usefulness in the total cases in the CAZ group and the CTM group were 71.6% and 66.7%, respectively, without significant difference between the groups. From the above findings, CAZ, like CTM, is considered to be useful in the treatment of suppurative otitis media.

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Fluorography using contrast medium is one of the common examination to determine type and degree of dysphagia. There is, however, room for improvement in medium since the degree of dysphagia depends on the characteristics such as viscosity and solidity of meal. Therefore, we newly used two types of barium meal, thin (100%W/V) and thick (200%W/V) and applied these media to 15 patients with lump sensation. According to radiographic findings, patients were classified three types, normal, border line and dysphagic. We believe fluorography using these media is useful to determine the type of dysphagia.

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To evaluate the swallowing function in the pharyngeal stage more precisely, we devised a solid bolus made of cake powder, barium sulfate and water. Fluoroscopic examination of pharyngeal swallowing using the solid bolus was able to reveal subclinical dysphagia. It was considered that the solid bolus imposed a kind of load on the pharyngeal swallowing and increased the degree of abnormality. We reported the characteristics of our solid bolus and the cases whose pharyngeal swallowing functions were evaluated using it.

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Patients with head and neck malignancy who undergo radiotherapy frequently complaint of dysphagia due to dryness of mouth and throat. We measured volume and viscosity of total saliva at rest and with stimulation of citric or tartaric acid in 10 normal adults and 2 dysphagic patients who had undergone radiotherapy. Remarkable decrease in volume of total saliva (0.04ml/min) was observed in a patient and moderate decrease (1.26ml/min) was observed in the other patient in compared with 2 normal subjects (2.15ml/min, 2.23ml/min). There was no apparent relation between viscosity of saliva and degree of dysphagia.

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A patient with dysphagia caused in polymyositis is presented. The most notable finding was that the disease was localized in the inferior pharyngeal muscles. Fluoroscopic, manometric and electromyographic examinations revealed the normal relaxation of the cricopharyngeal muscle during the pharyngeal stage of deglutition, the weakness of pharyngeal contraction and the failure of passive dilatation of the esophageal inlet. The cricopharyngeal myotomy was successfully performed and the patient is well controlled by the postoperative administration of steroid.

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This report dealt with dysphagia in the patients with spinocerebellar degeneration (abbreviation, SCD). Three cases of olivo-pont-cerebellar atrophy, which are one of the type of SCD, with dysphagia were reported. The first case was a sixty-nine-year-old man with an accident of bread hypopharynx foreign body. The second case was a fifty-five-year-old man with bilateral vocal cord paralysis. He was tracheostomized and cricopharyngeal myotomy and infrahyoid myotomy were performed at the same time, because dysphasia was supposed to be deteriorated. The third case was a thirty-eight-year-old woman. After she discharged, she stayed in a facilities for the handicapped. Her general condition got worse due to progress of her dysphagia and spastisity and rigidity by the side effect of anti-parkinson drugs. After her hospitalization, tube feeding improved her general condition. In the patient with SCD management of dysphagia is required to keep their swallowing ability. The management consists of assist of their eating, some device of food and operation to dysphagia.

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[in Japanese]

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[in Japanese]

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