A case of bursa type Tornwaldt'sd iseasei s herein reported. T he patient was a 67-yearo ld womanw ho complained of postnasal drip. Her complaint did not disappear after an incision to the bursa, however, the symptomsd id finallys top after performinga bursectomyT. ornwaldt'sd iseasei s classifiedi nto two types the bursa type and the cyst type. The choice of operative therapy is also discussed based on these two different types.

View full abstract

Acquired atresia of the external ear canal frequently occurs at either the aperture or the cartilaginous portion of the ear canal and usually originates either posttraumatically, postoperatively or after an inflammation. In this study, five ears of three cases with postinflammatory atresia are reported. The atresia occurred due to a thickening of the ear drum at the bony portion which looked very similar to either the superficial tympanic membrane or lateral healing after myringoplasty. Regarding etiological factors, chronic otitis media in three ears of two cases and chronic otitis externa in two ears of one case were suspected. We operated on four ears and a thick fibrous tissue was removed from the deep portion of the ear canal. However, the tympanic cavities were almost normal in all ears. The exposed bony surface was covered with a Thiersch graft and provided good results. Histopathological studies revealed chronic inflammatory changes in one ear and fibroadipose tissue with no clear inflammatory findings in three ears, and all of these complications were difficult to explain. Further studies are therefore considered necessary in order to better elucidate this problem.

View full abstract

The results of T & T olfactometry were analyzed in 46 patients with chronic sinusitis who were treated surgically, and in 19 patients without sinusitis who were treated by deviatomy and the resection of inferior turbinate. Although severe dysosmia was demonstrated in most patients with chronic sinusitis before the operation, it was only slightly observed in most patients without sinusitis. One month after the operation, the dysosmia improved in 21 (46%) of 46 patients with sinusitis, while it deteriorated in 7 (15%) patients and did not change in 18 (39%) patients. One year after the operation, the dysosmia improved in 17 (37%) of 46 patients with sinusitis, while it deteriorated in 13 (28%) patients and did not change in 16 (35%) patients. Although a nasal polyp was demonstrated in 11 (85%) of 13 patients with a deterioration of dysosmia, no such polyp was evident in 4 (24%) of 17 patients who showed an imporvement of dysosmia. These findings suggest that the dysosmia was mainly due to inflammation in the case of sinusitis.

View full abstract

Pollen from trees of the Taxodiaceae family (Cryptomeria japonica and Metasequoia glyptostroboides) and the Cuppressaceae family (Juniperus rigida), which are mainly found in the southern part of Okayama prefecture, was detected in the atmosphere. We performed scratch tests using pollen extract from both Taxodiaceae and Cupressaceae on 44 patients with allergic rhinitis. We observed that 26 (59%), 4 (9%) and 6 (19%) of the 44 patients reacted positively to the allergen extract from the pollen of the Japanese cedar, Metasequoia and Japanese juniper, respectively. In addition, only 1 of the 6 patients (17%), who reacted positively to Japanese juniper, failed to react to the other extracts, which strongly suggested that pollen grains from the Japanese juniper also cause pollinosis.

View full abstract

Someo f the various clinicalp roblemsi n myringoplastyw, hichi s the last stage of tympanoplastyf or all kinds of middle ear diseases, a re herien discusseda s follows:
1. The five essentials for success in myringoplasty are listed and discussed as to how to best satisfy each essential requirement.
2. Concerningt he grafting materials, an autograft was recommendeda s the best one becausea homograft runs risk of causing Kreutzfeldt-Jacobd isease, w hile a heterograft has a higher chance of either rejection by the host or of developingg raft disease.
3. Amongt he 3 most commong rafting techniquesi ncludingt he underlay, o verlay and sandwichm ethods, the sandwichm ethod was recommendeda s the best.
4. Regarding the 6 potential outcomes of myringoplasty, t he inverted mucosa on the new ear drum, marginal cholesteatoma, and retraction pocket formation due to a dysfunction of the intratympanic ventilation were explained in particular detail.
5. The relationship between the supratubal recess and the tympanic diaphragm and pneumatization of the temporalb one were also explainedb oth embryologicallya nd anatomically.
6. Finally, the importance of anterior tympanotomy to prevent the retraction of the new ear drum was also emphasized.

View full abstract

Adult T-cell leukemia·lymphoma is caused by the Human T-call Leukemia Virus, type I: HTLV-I, and southern Kyushu is well known for numerous outbreaks of this disease in Japan. A67-year-old female presented with pharyngalgia and dyspnea. The otological findings revealed a tumor at the nasopharvnx and the palatine tonsil on the left side. This patient demonstrated positive anti-HTLV-I antibodies. The histological diagnosis was non-Hodgikin's diffuse medium size Tcell lymphoma. In spite of undergoing intensive chemotherapy, the patient eventually died 5 months later. A78-year-old female complained of hoarseness and dyspnea. The otological findings revealed a submucosal tumor at an arytenoid lesion on the right side. 12 days later, a palatine tumor arising from the left maxillary sinus also became visible. The patient also demonstrated positive anti-HTLV-I antibodies. The histological diagnosis was non-Hodgikin's diffuse medium cell type lymphoma. The immunohistochemical studies demonstrated that the tumor cells of T-cell lineage. In spite of undergoing chemotherapy, however, this patient also died 8 months later.

View full abstract

Fifty-eight patients from 80 years of age and upward with head and neck malignant tumors and who were treated at the Department of Otorhinolaryngology, at the University of the Ryukyus Faculty of Medicine from 1976 through 1991 are herein reviewed. The variety of primary sites included laryngeal cancer (18 cases), oral cavity cancer (12 cases), hypophryngeal cancer (9 cases), malignant lymphoma (9 cases) and mesopharyngeal cancer (7 cases). Sixty-three percent of the cases were detemined to be either stage III or stage IV. Curative treatment was planned for 30 cases (60%). According to the results, 13 patients survived, 32 patients died of primary disease and 5 patients died of other disease. It is therefore considered that curative therapy was indeed possible in some cases even though the patients were 80 years of age or older. From a practical viewpoint, an effective therapeutic approach must be carefully designed based on many factors such as the attitude of the patient toward the disease, the cooperation of the immediate family and the overall quality of life of the patients.

View full abstract

The author herein reports the results of therapy conducted on 25, 660 tinnitus ears over the past 10 years based on his experiments with cation (especially K. ⁺) which is thought to be responsible for tinnitus. The results were excellent as noted below:
1) The tinnitus-reducing effects were recognized in 79% or more cases through the combined treatment of three methods mainly consisting of intravenous injection and drug therapy of conjugated vitamins B (B1, B6, B12) along with the use of cortisone (chemical) and magnetic therapy (physical). The author thus considers the optimum length of treatment to be at least 3 months.
2) Roughly 30% of the tinnitus patients were in their 40's and 50's, while 54% were 60 or older. About 76% of the patients had inner ear tinnitus, while 24% had retrocochlear tinnitus. The combined treatment of these three methods was found to be effective for the former group of patients, while it was not effective for the latter group.
3) There was also a relationship between a deafness audiogram and tinnitus timbre. A prevalency was also noted in which those suffering from a high frequency hearing loss had high-tone tinnitus, while those with a low frequency hearing loss had low-tone tinnitus. In addition, the flat or trough type hearing loss patients had tinnitus, which was persumably a mixed timbre of the former two types.
4. It was found that the more recent the tinntus, the quicker and easier the cure. However, even in cases with a 5 year or longer history of tinnitus, the tympanic in-jection of cortisone and magnetic therapy proved to be effective.
5. Since the above therapeutic regimen works on cations, it was presumed that the membrane potential of hair cells and abnormal transmitters in end synapse might potentially be the cause of tinnitus.

View full abstract

A sonographic study of the oral cavity and oropharynx conducted using three types of a transducers. Transducer (A) is a small finger type, transducer (B) is a bar hole type and transducer (C) is linear array type. An intraoral ultrasonic scan using transducer (A) was found to be effective for evaluating neoplasmas of the tongue. Transducer (B) was useful for evaluating tumors of the softpalate and palatine tonsil. Transcutaneous ultrasonography by transducer (C) was found to be valuable in assessing the base of the tongue. Therefore, ultrasonography is considered to be a valuable non-invasive method for delineating tumors in the oral cavity and oropharynx.

View full abstract

In 1965 Soeda and Sambe extracted an antigenic substance from the urine of allergic patients and we named this substance MS-Antigen (MS-A). This agent has an antigenic character and has no allergy provoking property. The most striking finding is that both anaphylactic shock and Arthus reaction are suppressed by this substance. In a clinical study of MS-A, a 34-year-old woman was treated with this agent. She had been suffering from uticaria with beer or yellowtails as well as recurrent aphthous stomatitis for six years. Urticaria and recurrent aphtae subsided and disappeared simultaneously after the 25times injection of 40mg of this agent. We confirmed that MS-A was effective in treating recurrent aphthous stomatitis. Recurrent stomatitis is related to various factors. It was postulated from the results of the above allergy tests (family anamese, complications of allergic diseases, skintest, etc.) that recurrent aphthous stomatitis, including Behcet's disease, might be allergic and thus the treatment with this agent was carried out. Behcet's disease is a very difficult disesase to treat and the chief symptoms are aphthous stomatitis, uveitis and pudental ulcer. We have now treated 4 cases of Bebcets's disease with this agent and obtained good clinical results: Up to now two cases were excellent, one case was good and one case was poor. Clinical results of 46 cases of recurrent aphthae: Excellent responses were achieved in 16 cases and satisfactory responses were achieved in 19 cases. In addition, no adverse side-effects have been observed.

View full abstract

Twenty-six patients with unilateral chronic sinusitis were given 150mg of roxithromycin (RXM) twice a day for eight weeks. The rates of improvement in the subjective symptoms after therapy were as follows: nasal discharge 82%, nasal obstruction 96%, sensation of a foul order 17% and headache 80%. The objective findings improved as follows: the volume of nasal discharge 74%, the contents of nasal discharge 65%, the volume of postnasal discharge 75% as well as flare-up, edema and swelling of the nasal mucosa 48%. The total improvement rate of the subjective symptoms and rhinoscopic findings was estimated to be 73%. The Xray opacity of the maxillary sinus of Water's view was evaluated quantitatively using a microdensitometer and a film digitized system. The measurement of Xray opacity of the maxillary sinus by both X-ray and analytical methods was found to be useful in making a quantitative evaluation of the pathological conditions of the sinus. The ratio of the maxillary sinus density to the orbital density (M/O ratio) significantly improved compared to that before and after the treatment. Therefore, long term RXM therapy is considered to be useful for the treatment of unilateral chronic sinusitis.

View full abstract

The stabilograms of subjects standing still while undergoing impulse stimulation were analyzed. This challenge was designed to test the postural restoration reflex system, which the stabilogram at rest cannot do. The response for a stabilogram regarding the center of gravity was measured and analyzed with the damping coefficient used as an indicator when two kinds of loads, namely, impulse simulation and mild impulse were both applied as stimulating input. Using the mild impulse stimulation, the lineality of the response was examined by spreading an impact buffer mat under the subject. Based on the results of impulse stimulation, the subjects were then divides into the normal group, the vestibular disorder group and the central disorder group; a singnificant differece in the damping coefficient was noted between the groups. Using a mild impulse as stimulation, the subjects mostly consisted of patients with a unilateral vestibular disorder; the damping coefficients on correcting the stimulation in the direction of the affected side was significantly smaller than the damping coefficient for correcting the stimulation on the healthy side. Based on the above findings, this testing method is therefore considered to be useful for screening patients presenting with dizziness.

View full abstract

In the head-up position, horizontal head rotation stimulated the horizontal canal which causes the horizontal vestibuloocular reflex (HVOR). In the supine position, vertical rotation stimulates both the canal and the otolith organs, which causes the vertical vestibulo-ocular reflex (VVOR). The dynamic otolith response was then studied by comparing these two types of harmonic rotation in 19 normal adults. Using a static analysis of variance (ANOVA), a significant difference was found to exist between the HVOR and the VVOR (p>0,05). The VVOR indicates a higher gain in the lower frequency such as 0.17Hz, and a higher phase lag in the higher frequencies such as 0.67 and 1.0Hz. The dynamic otolith response is characterized by a so-called low pass filter, which suggests that the otolith organs support visual fixation while the head movements in lower frequencies decrease the canal function. At VVOR no significant difference was seen between the supine and prone positions, and thus the various outputs of the otolith ocular reflex may not affect the in-put phase. Based on the findings of this examination for the patients with 4 acoustic tumors who demonstrated complete canal palsy, a unilateral otolithic lesion does not alway cause decrease in gain of the otolith ocular reflex. In the 6 benign paroxysmal positional vertigo (BPPV) patients, a variable value of the gain was observed which may have been caused by some otolithic lesion.

View full abstract

In most cases of cervical esophageal cancers, total cervical esophagectomy with total laryngectomy were done, we had a study of swallowing function in rare case of total esophagectomy by left thoractomy with reserving larynx, reconstructing with free transplantated jejunum between lower larynx and gastric tube. The patient was 50 y. o. male, with advanced ulcerating cancer in cervical portion and superficial cancer in middle and lower thoracic portion of the esophagus (multiple cancers), the staging was A 0 N 1 P10 M0, stage II. In upper G1 series, radioisotope test with Tecnecium, the patient could swallow without aspiration, In manometry, the 1st perisfaltic wave was appearing thougth its amplitude was not as high as normal, and UES was existing. Then swallowing function was mostly reserved in this case. In conclusions, if the patint is young (under 80 y o.), and the cancer's depth of invasion are not seen on adventitia, we should reserve the larynx utilizing free transplanted jejunum.

View full abstract

Seventy-one year old Japanese male with advanced hypopharyngeal carcinoma (T4N2M0), originating from right pyriformis sinus, extending to the inferior border of torus tubarius, was totally laryngopharyn- gectomised after preoperative irradiation with total dosis of 41.2 Gy, followed by free jejunal autograft in loop-like fashion with wide opening for oral side. Dysphagia such as food retention at the site of pharynx due to a hammock like hollow and stenosis of the esophageal junction have continued postoperatively, but the latter of which was improved by repeated therapy using bougie. At the time of laparotomy, a sigmoid colon carcinoma invading pelvic cavity was incidentally found. After removal of the colon, colostomy was performed. The pelvic lesion was treated with chemotherapy including CDDP, leukovolin and 5FU followed by irradiation with total dosis of 51.2 Gy. Preoperative anorectal examination was necessary especially in case of the hypopharyngeal carcinoma.

View full abstract

Postoperative oral function of recent oral cancer patients has been studied, and the results was compared from various points of view. In this paper, we investigated oral function from the point of the size of excision and reconstructive method. For 24 patients after glossectomy and mandibulectomy, tongue mobility was tested and mastication and swallowing ability were examined by questionnaire. The results were as follows: Functions were limited in proportion to the extent of tongue resection. In addition, resection of oral floor affected tongue mobility, and swallowing ability was lowered by tongue base resection. There was little defference in function among the patients who have been reconstructed by free flaps and myocutaneous flaps. Patients with marginal resection of mandibule, showed better mastication than those with segmental resection, and this was concerned with dental rehabilitation. Whether mandibule was reconstructed by plate or bone was not significantly different in our results, but this may affect occlusal rehabilitation.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract