The author studied the audiograms of 957 patients with hearing difficulty, who were examined in the Tohoku University Hospital. Symmetry of bilateral audiograms were found in high percentage in the cases with strepto-mycin deafness, acoustic trauma, familialy deafness, (chronic progressive labyrinthine deafness), presbyacusis, deafness following febrile diseases and few others. Except familialy deafness, all these have been considered to be acquired deafness, so that it was contrary to the Langenbeck's Symmetry low that the Symmetry of bilateral audiograms indicate the hereditary diseases. Considering the clinical evidences, the author concluded that these findings were due to congenital vulnerability of ears and were not contrary to Langenbeck's Symmetry law.
Previously, I had studied the water content of the blood after stimulation by accerelated rotation and found its decrease due to a sympathicotonic change brought about in the living body by accerelated rotation through labyrinth. This time, however, I made an observation of the water content of the blood during stimulation by accerelated rotation, and found that the water content of the blood was decreased throughout the duration of stimulation, showing that the living body was in sympathicotonic condition. Further, by giving an intravenous injection of sodium bicarb-onate solution beforehand, the decrease in the water content of the blood during stimulation could be prevented.
The authors reported a 32-year-old woman suffered from the cystoma in the left frontal lobe (Fig.3). Her hearing acuity on the same side was impaired with the type of gradual high tone loss by about 40 db (Fig.1-2). Moreover, when the pressure of the cerebrospinal fluid elevated, the hearing acuities on both sides were temporarily impaired for low tones (Fig.1), that is to say, the hearing of the left ear was impaired for all tones. At the autopsy, the atrophy and the edema of the nerve cells due to the tumor were revealed in the Heschl's gyrus of the left temporal lobe (Fig.4-11). The bilateral low tone deafness might be due to the transient hydrops of labyrinth and the compression to the trunk of the cochlear nerve, that were induced by the elevated pressure of cerebrospinal fluid, and the high tone deafness on the left side partially might be due to the degeneration of the temporal lobe, which was mentioned above. The localization of the cerebral acoustic area was discussed from the following fact that the hearing acuity on the opposite side was almost intact in spite of the degeneration of the temporal lobe.
On the ear of 112 cases for which radical mastoidectomy had bee done, the auther perfor-med the audiometric test of hearing on bone and air conduction. The results were as follows; 1)In the cases whose hearing improved after operation the upper limit of air conduction hearing reached to the 25 db line on the audiogram. 2)The postoperative hearing was mainly depend on the mobility of the stapes and the round window membrane, and the condition of the tympanic cavities whether they were dry and thinly epidermized or not.
Clinical observations were made on 112 cases of supprative middle ear infection for which were operated by radical mastoidectomy had been performed. The air and bone conduction audiometry was done before and after the operation. The changes of hearing by radical mastoidectomy was mainly depend on the postoperative condition of the round and oval windows, and the preoperative impedance matching of the sound transmitting apparatus which were influencedby the pathological changes of the tympanic membrane and the other middle ear apparatus.
The author evaluated the curative effect of nasal irrigation given collectively to school children with chronic sinus infection. Seventy-five affected children were treated by the nasal irrigation with saline solution for 3 months. At the end of the 3. months' treatment, the findings in the treated group were considerably improved compared with the contrast group, without treatment the difference being significant statistically. However, this difference in the findings in the nose between the two groups disappeared soon after the cessation of the treatment, revealing the fact that the curative effect of the nasal irrigation in chronic sinusitis was no more than a symptomatic.
Since Proetz's discription in 1926, a number of reports have been written on his displacement irrigation and the method has been widely adopted as a conservative treatment of choice for chronic sinus infection. The author attempted to evaluate the curative effect of the displacement irrigation given collectively to school children with chronic sinusitis. Eighty-three affected children were selected and treated for 3 months with a follow-up observation of 6 months. Simple saline solution was used for the irrigation. The results were satisfactory. Findings in the nose of the treated group were significantly improved as compared with the contrast group, without treatment and this significant improvement continued for about 3 months after the cessation of the treatmnet.
Since Dean, vitamin A deficiency has been considered as a cause of chronic sinusitis. The author attempted to use vitamin A and D as a therapeutic agent to the disease and administered daily 15, 000 to 45, 000 units of vitamin A with 4, 000 to 12, 000 units of vitamin D to 265 affected school children. The improvement of nose findings in the treated group was not significant as compared to that in the group without administration of the vitamins. The author deduced from the result of observation that the use of vitamin A was not effective in the treatment but in the prevention of chronic sinusitis in children.
The author studied the influence of the labyrinthine stimuli upon waterdiuresis of the normal water-loaded man. Oliguria was seen in seven subjects out of seventeen when the-ordinary clinical stimuli (rotation or calorisation) were giver. But when the subjects shaked the head periodically (T=4 Sec.) for about five minutes during the rotation, urinary flow was. always reduced remarkably. On the other hand, waterdiuresis in twenty patients of Meniere's disease was examined by-waterloading, and antidiuresis was found in four patients. This antidiuresis seemed to be-caused by the dizziness attack produced by waterload, or by the labyrinthine stimuli to which they were always exposed. Mechanism of antidiuretic effect of the labyrinthine stimuli was discussed, and the author suspected that it would be due to the incresse of the serum antidiuretic substances, and in Meniere's disease, so-called "circulus vitiosus" was formed by the antidiuresis and the labyrinthine stimuli (dizziness attack).
The author studied 40 sinuses using a newly designed antroscope, introduced into the sinuses through the bony wall of inferior meatus of the nose. In some cases, verious kinds of function tests were done and also pictures were taken. 1) The author classified the inflammatory changes of the sinus mucosa into following types, namely edematous, polypoid, and granulomatous type. The changes at the ostium and surroun-ding tissue were classified into normal, hyperplastic, obstructive, and covered type. 2) Pathological changes at the ostium appeared to have undesirable influence on the severity and chronicity of the sinus infection, inhibiting ciliary and evacuation function of mucosa. 3) There were close correlations between the pathological changes of the ostium and quantity of secretions, deviation of the septum, degree of obstruction in the middle meatus and haziness of anterior ethmoid cells on X-ray films. 4) The ostium showed an active dilation of the opening during the inspiratory movement. In the cases which did not show the dilation, fibrotic changes, especially perivascular fibrosis were prominent. 5) By photography, the author demonstrated u certain rule in evacuation of the secretion. At the ostium, there was an evidence that the contents of the sinus were sucked out to the nasal cavity proper. There was a constant route in evacuation of the secretion, and the rest of the mucosa were in the condition so called "schunutig off" 6) Antroscopic examination is an useful method to evaluate the condition of the ostium and also in the diagnosis of antral polyp.
Author made an observation of bone pathology in the patients with chronic suppurative sinusitis. Results of histopathological observation were as follows: The pathological changes of the bone in maxillary and ethmoid sinuses were found in 25% of the cases, though the changes were not remarkable. In 75% of the cases, changes in the bone were within normal limits. In addition, changes in mucous membrane, laboratory tests and many clinical problems were discussed.
Experimental acute otitis media was produced by injecting various agents into the middle ear cavity of the guinea-pig and the animal was sacrificed for histological studies after 7 days of careful observation. The results are summarized as follows: 1) The introduction of bacteria suspension, egg albumin or milk into the healthy middle ear cavity produced the proliferation of the connective tissue and the infiltation of neutrophilic leucocytes in the mucosa, The secretion in the middle ear mostly consisted of the neutrophilic leucocytes. The introduction of egg albumin and milk produced a milder inflammation as compared with that of bacteria. No eosinophilic leucocytes were found in the lesion of these series. 2) In the guinea-pigs sensitized with egg albumin or milk, the introduction of the antigen agents into the middle ear cavity led to the allergic changes characterized by the edema, hemornhage, vascular dilatation, production of fibrin and the infiltration of eosinophilic leuco-cytes in the tympanic membrane or mucosa of fhe tympanic cavity. The secretion was also characterized by fibrin clots, blood, and eosinophilic cells. 3) When the egg albumin was employed as the antigen, the pathologic process was chara-cterized by high degree of edema, while with milk it is characterized by hemorrhage and fibrinous exudation. It is evident that different antigen gives rise to different histopathologic manifestations. 4) The injection of bacteria suspension into the tympanic cavity of the sensitized guinea-pig resulted in the edema, vascular dilatation, eosinophilic infiltration and hemorrhage, which are similar to the allergic response of the tympanic membrane or the mucosa of the cavity. However, these changes are much milder as compared with those produced by true antigen-antibody reaction. The edema, in some instances, was absent. Neutrophilic leucocytes are the chief constituent of the middle ear secretion, but in many instances, fibrin clots and eosinophilic cells were demonstrated. It is clear that the sensitized mucous membrane differs entirely in the reaction to bacteria from the intact membrane. 5) In non-allergic reaction, eosinophilic cells are scarcely detected in the tissue or secretion, but in allergic response, eosinophilic leucocytes are demonstrable in all instances. It is, therfore, considered that the presence of eosinophilic cells in case of acute otitis media is characteristic to the allergic nature of the inflammation.
Though the familiar prevalence in chronic sinusitis was already recongnized especially, no investigation had been made. The author conducted rhinological examinations on series of 152 families consisted of 304 parents and 536 children and analyzed statistically the results of examinations following to the method introdeced by Araya in 1939. The analysis revealed the fact that there existed a significant familiar prevalence in the incidence of chronic sinusitis. Besides, the author observed a close correlation in the incidence of the disease between parents and children as well as between siblings.
Investigating the influence of heredity in the incidence of chronic sinusitis, the author examined rhinoscopically as well as radiologically the incidence of chronic sinusitis in 38 pairs of monozygotic and 22 pairs of dizygotic twin and compared the clincal figures between each twin. A significantly higher similarity in the signs and symptons of chrcnic sinusitis was achieved between monozygotic twins than that between dizygotic twins, implying the fact that heredity played a difinite role in the development of chronic sinusitis.
The author investigated to relationship between chronic sinusitis and several types or signs of constitution constitutional anomalies:i.e. constitutional anomalies determined by Enjoji's chart, allergic diathesis, lymphatic diathesis, tendency of recurrant colds and tendency of unba-lanced oppetete. Results obtained from the observations carried on 627 school children aged from g to 12 years showed the fact that chronic sinusitis, especia11y that of catarrhal type;occured more frequently to those who had some of the above-mentioned constitutional anomalies.
The author reported a case of braintumor in a 18 years old girl, who had complained of vertigo, deafness and tinitus in the early stage, and then showed brain symptoms and died in 2 months. Autopsy revealed a glioblostoma arising from the cerebeilopontile angle of the brain. 1) This case was rare type of acoustic tumors. 2) This tumor was extremely malignant and very rapidly grew up the brain, and the symp-toms were very serious.