With the purpose to study the influences of the separation of the incudostapedial joint and the granulation tissue in the vicinity of the joint, which are often encountered among other impairments of ossicular chain conduction at the time of tympanoplasty, and also to study the improvement in the sound conduction when the broken ossicular chain is repaired, the author a series of experiments by various artificial manipulations to the incudostapedial joint in cat, and electro-cochlear responses were examined. The results are as follows: 1. When the capsule of the incudostapedial joint is severed but the joint surfaces of the incus and stapes are still in contact, a loss of cochlear potential under 10db has been observed in the entire frequency range, but the loss in the low tone range is somewhat greater than in the high tone range. 2. When the joint is completely separated, it shows the maximum loss of cochlear potential of 61.5db at 1, 000cps, showing a tendency to have somewhat less loss in the high tone or in the low tone range. 3. When a small piece of muscle is inserted into the separated joint, the loss of cochlear potential has been found greatest (33.0db) at the low tone, and the loss tends to lessen in the region closer to the high tone, When this is compared with the cochlear potential in the case of complete separation of the joint, it has been observed that an increase of the potential of about 30db at 1, 000cps. The degree of the rise is marked in the middle tone range, followed by the low tone and then the high tone. 4. When the separated joint is connected together by acryl cement, the loss of about 10db has been observed in the entire frequency range, but the loss in the potential at the high tone range is greater than in the low tone. In comparing cochlear potentials in this instance with those at the time when the joint is completely severed, a marked rise in the entire frequency range has been observed. The extent of such a rise is most marked at 1, 000cps, followed by the low tone and then the high tone. 5. In tympanoplasty, the connection between incus and stapes should be maintained as much as possible in the case where only the capsule of the joint is damaged but the incus and stapes are still in contact. 6. In the case where the separated joint are connected by granulation tissue and the patholo- gical change appears to be slight, a consideration should be given to not remove the granulation tissue in the joint. 7. It is concluded that in the case where the incudostapedial joint is completely separated, reconnection of the separated ends needs to be considered and the material for such reconstruction should be farther studied.
(1) Separation of the Ossicular Chain (2) Reconstruction of the Broken Ossicular Chain (3) Granulation in the Tympanic Cavity adjacent to the Ossicular Chain In order to evaluate the effects of each of these three factors on the sound conduction mecha- nism and to contribute fundamental knowledge for the performance of tympanoplasty, a series of experiments, has been conducted by manipulating the incus and its surrounding region in various manners, and the following results were obtained: 1. When a small piece of muscle is inserted into the region adjacent to the ossicular chain around the incus a loss of cochlear potential in horizontal form of about 20db has been observed in the entire frequency range examined at 250-8, 000cps. 2. When only the incus is removed without injuring other ossicles, the maximal loss in the potential (59.0db at 1, 000cps) has been observed. This loss decreases in the region either near the low tone or near the high tone. However, in comparison with the loss shown in the case of com- plete separation of the incudostapedial joint, the loss in the potential at the time of removal of the incus is slightly smaller. 3. When a small piece of muscle is inserted into the tympanic cavity which incus has been removed, the loss in the potential shows the maximum (45.5db) in the low tone range; and when it is closer to the high tone range, the loss tends to decrease accordingly. Comparing this value with the potential loss in the removal of the incus, in the later the cochlear potential is greatest at 1, 000cps and the potential either in the low tone or in the high tone range is less than 1, 000cps. 4. When the neck of the malleus and the head of the stapes are connected by bridging with acryl cement bar after removing the incus, there is a loss of about 15db in the cochlear potential but no marked dip in frequency. Comparing the potential with that in which incus has been remoned, the increase in the potential is greatest in the middle tone, followed by the low tone and then high tone range. 5. For the cases where the incus is missing, it would be Letter to consider some suitable material for bridging the malleus and stapes aside from the conventional operation using the stapes as columella, in which there is often an attendant danger of skin flap adhesion. Therefore, it is hoped that there will appear some suitable material for the connecting of ossicles. 6. As for the influences of the granulation tissue in the tympanic cavity to the sound condu- ction, the granulation tissue itself is assisting the sound conduction in some degree when the ossicular chain is broken; and when the chain is intact it interferes the conduction in various degrees. From these aspects, in the cases where the conductive system is connected by granulation tissue, the removal of granulation tissue diminishes the hearing capacity. Therefore, it is concluded that a consideration needs to be made before removing such granulation tissue.
P32 metabolism in the central pathway of the cochlear nerve of the rat was examined to study one aspect of dynamic biochemistry of nerve fissue, and also biochemical mechanism in the phys- iology of audition. Normally, the quantity of P32 which was transferred into the tissue of the central nervous system was quite small. P32 was transferred first to the acid soluble phosphorus fraction and them to nucleic acid protein fraction. The transfer to the lipoid fraction was, though it took place last, greatest in quantity. An experiment with 5, 000 cps pure tone of 110 phon revealed that the transfer of P32 to the nucleic acid protein of the central pathway of the cochlear nerve was enhanced by a brief stim- ulation and suppressed by a long lasting stimulation. This phenomenon was especially remarkable-in in the lower terminal nucleus. By the administration of Dihydrostreptomycin the transfer of P32 to nucleic acid protein was inhibited. To reproduce these in vivo findings appropriately in vitro, the experiment of P32 transfer was made, by measuring oxygen consumption with the Warburg apparatus. The P32 metabolism sho- wed the same tendency both in vivo and in vitro. In this in vitro experiment, . by addition of vit- amin A or ATP preparation, the transfer of P3 to the nucleic acid of the central pathway of the- cochlear nerve was enhanced. In the nervous tissue in which carbohydrate metabolism plays a most important role, the metabolism of phosphorus seems to be essential to maintain its function.
The amount and the route of distribution of antibiotics in the maxillary mucous membrane was studied when they were systemically adminstered for chronic maxillary sinusitis. Penicillin concentration in circulating blocd and the blood which was distributed to the maxillary mucous membrane were compared, after the intramuscular administration of crystalline sodium penicillin. The ratio of the concentration was 10: 7. For the determination of the Penicillin concentration in the maxillary mucous membrane, a new accurate method using the following formula was suggested by the author. S (unit /cc)I×15 (cc) /W(g)=S'(unit/g) S'/B × 100(%) = K K: Distribution Ratio. Obtained concentration of penicillin in the maxillary mucosa was compared in percentage with that of circulating blcod. This was called " The antibiotic distribution ratio to. the maxillary mucous membrane ". Majority of cases measured, showed the ratio of 40-80%. Having examined the relationship between the distribution ratio and histopathological findings of the maxillary mucous membrane, the following results were observed. In the cases with high percentage of the distribution ratio, the mucosa showed many blood vessels. In the cases with low percentage, a small amount of blood vessels, thickening of the wall of the blood vessels, obliteration of the blood vessels, the existence of ' Polster' etc. were observed. No significant relationship between this distribution ratio and other histopathological findings was recognized.
Although histology an, d cytology of the human nasal glands have been studied by many the fundamental knowledge is left inconclusive. The author carried out detailed observations on the glands of human nasal mucosa in 60 cases. The results are summarized as follows 1, There are two kinds of nasal glands, the smaller and larger ones. The former is located in the lamina propria immediately beneath the epithelium, while the latter is found in the deep layer of the mucous membrane. In areas where the mucous membrane is relatively thin., even larger glands' are located beneath the epithelium extending parallel to the epithelial. surface. Thus the position and extension of the glands may depend upon the thickness of the mucous. membrane. 2. The small glands have no excretory ducts but the glandlar tubules (secretory portion) open directly on the epithelial surface. Some of the larger glands have their own excretory ducts, but most of them are lacking of those and open directly in a like manner as do the smaller glands. The excretory duct has a large tubular lumen and is lined with pseudostralified epithelium which is composed of two kinds of cells, the taller and shorter, both of which stand upon the basement membrane and appear like two layered stratified epithelium. The duct is turtuous and its branching was never observed. 3. In parts between the excretory duct and the secretory portion, the striated portions are recognized in some, but the incidence is considerably rare, viz., being found in only 4 cases. The so-called basal striation is found at the basal parts of the epithelial cells of the striated portions, where the cells align in a simple columnar epithelium. A small number of such basally striated cells may appear among the epithelial cells of the excretory duct. Primary branching of the striated portions could be observed. 4. The opening of the nasal gland is observed on the free surface of the epithelium in some cases, and in the epithelial recess in others where two glands may frequently open in a single recess. 5. Neither pure serous nor pure mucous glands present. All of them are mixed glands of either branched tubular or branched tubulo-alveolar form. As the excretory duct does never branch, even the gland with an excretory duct and branched secretory portions may be called the simple gland. In smaller nasal glands the branching of the glandular tubules is rather-simple, whereas the tubules of large glands branch for sevearl times in a complicated manner. Branching of the gland tubules is always observed even in the simplest small glands, and neither unbranched nor intraepithelial gland appear in the human nasal mucosa. 6. About the arrangement of mucous and serous cells in the nasal glands a definite law may be recognized. Namely, the mucous cells are situated at the proximal part near the opening, while the serous cells at the distal part of the gland tubule. The mucous cells form mucous secreting glandular tubules, i.e., the mucous tubules (Schleimrohr), which branch for several times. A rather thick main portion has a dilated lumen which empty into the excretory duct, striated portion or directly on the surface epithelium. To the mucous tubule, mostly tubular or sometimes alveolar serous secreting portion opens. Some of serous glandular tubules primarily branch. Mainly at the terminal portion of branches of the mucous tubule, a plenty of demilunes formed by serous cells are observed. The serous glandular tubules and demilunes form the terminal portion of the nasal glands. Some of the serous glandular tubules open directly on the wall of excretory duct. 7. A number of demilunes are always found in the human nasal glands. The shape and size of demilunes are various, and at the terminal portion of one mucous tubule several numbers of demilunes could be seen. Some of the damilunes project themselves outward and they seem to be the transitional forms into serous glandular tubules.
The author suggest a new method for the determination of the transition zone (range of fluctuation) of the pure tone threshold which fluctuate from time to time. By this method, the transition zones were deterinined in those with normal hearing and those with hearing difficulty. The conclusions were as follows (1) The transition zone in those with normal hearing was about 8 db. (2) By means of this method, not only the magnitude of fluctuation, but also the actual shapes of its fluctuation are also to be observed. (3) Accordingly, presence of the factors that disturbe the precise measurement of threshold, their grade and nature are clearly demonstrated.
Of surgically removed tonsils the histopathological pictures and the distribution of the nerves, especially of the vegetative nerves, were systematically studied. In all cases cornification was found in the stratified squamous epithelium of the oral surface of the tonsil. The histological structure of the capsule of the tonsil showed a considerable individual difference. The course of the skeletal muscle fibres and bandies were especially .different. Frequently they ran closely to the parenchyma and entered into the inlet of the septum. Therefore, histologically, the so-called capsule is a portion of the tunica propria of the oral mucous membrane and should not be regarded as an entity. On the basis of these findings tonsilar abscess was assumed to be formed in the parenchyma -or in or out of the capsule under certain conditions such as the bacterialtoxicity and the resistance of the patient. Considerations were also made on the nature of peritonsilar abscess. The sensory nerve endings were sparse in the tunica propria under the epethelium. Relatively numerous simple and complicated arborating endings were found in the capsule, especially in the transitional part to both palatine arches. Un-arboraing endings and rarely simple glomerular endings were also observed. In the tonsilar parenchyma and septum simple and complicated arborating endings were also found. However, the epithelium showed no nerve ending. The vegetative nerves were richly found and implied the importance of the position of the tonsil. They sent nervous anastomoses to the vascular walls and were widely distributed forming the so-called terminal net work of the vegetative nerves. It was especially noteworthy that neurofibrillae entered from the surroundings of the lymph follicles into the germinal centres accompanying the precapillaries which were radially distributed in the follicles. On the basis of the above stated findings the intense pain of peritonsilar abscess was easily explained. Thus, in tonsillectomy, injection of the anesthetic to the tonsilar capsule, especially at the transitional part of both palatine arches, was indicated and the focal infection of the tonsil, e.g. myocardial disturbances due to peritonsilar abscess, was considered from the stand -point of the Reilly phenomenon.
Investigating auditory organs, noses and pharynges of 124 T-33 Jet Pilots, the following results were aquired. By audiogram conducted by air, disturbances were found in 39% of all cases, namely dip form 17.0%, rising form 9.8%, abrupt form 5.0%, flat form 4.9%o and convex form 2%. Abnormalities of the auditory osgans were found in 46.8% of all cases, namely retractation of the tympanic membrane (30%), turbidity (25%) and then in a few cases hyperemia, swelling and scaring. Abnormalities of the nose were observed in 56.5%. Deviations of the septum (35.5%), hyper- trophic rhinitis and chronic rhinitis were common. Pharyngeal abnormatities were found in 19.4% of all and most of then were chronic tons- illitis. Objective symptoms of the ears during the flight were seen in 31% and that of the noses in 33%. The complaints were such as an obstructive footing of ears and nasal dryness. Otalgia, blocking feeling of their ear and nose and dyspnea were complained very often during the flight Tinnitus and difficulty in hearing, were complained after landing. In 80 to 90 % of the cases, synptoms disoppeared soom after the landing.
Thiamine propyl disulfide (Alinamin) was used in the treatment of perceptive deafness in children. Daily dose of from 30 to 60 mg. of Alinamin were administered oraly to 11 patients aged from 4 to 13 years whose hearing impairment was perceptive one. The administration was continued for 1 to 4 weeks. Marked improvement of hearing was achieved in 5 cases out of total 11 cases, implying the fact that oral administration of Alinamin was to be recommended as a method of choise for the treatment of perceptive deafness in children.
Two cases who complained of unilateral deafness and were proved to be malingerers, were reported. The one had been injured by gas explosion and the other by a blow on his left mastoid region, bad been complaining deafness of the left ear for 6 months. During which periode there has been no improvement. However, examination revealed that they were malingerers. Stenger's test and the Delayed Side Tone Test were voluable for the diagnosis of malingering, and the latter played an important role to determine the threshold in hearing difficulty.
Indication of a hearing aid is best to be determined by the articulation test in the free field, both with and without the hearing aid. The hearing ability for speech was recorded on the following three scores, i.e.. hearing loss for speech, articulation score at 65 db sensation level and social adequacy index, which are drawed from the syllable articulation curve. The efficiency of a hearing aid was determined from these three scores as follows and from this results the application of a hearing aid may be indicated.
As previously reported, the speech audionietry done for the patients who wished to use a hearing aid and from the articulation score the next conclusions were derived: 1) The need of a hearing aid is not necessary indicated only by the results of the articulation, score. 2) The need of a hearing aid may be ever more indicated by the articulation curve for syl- lables than that for speech sounds. 3) A deaf patient whose articulation at 65 db sensation level a hearing aid is 75% or more, may not need a hearing aid. 4) One with perceptive deafness whose articulation score for syllables at 65 dh sensation level is less than 5% could expect to his hearing by a hearing aid. 5) When the articulation score for syllables at 65db sensation is recorded between 5% and. 25% and the deafness type is perceptive, some patients of this type can obtain some improvement of hearing by the use of hearing aids.
According to the social adequacy index estimated by the foregoing free field speech audiometry. the next conclusions were obtained: 1) A patient whose social adequacy index from the articulation curve for syllables is less than 65, does not need to use a hearing aid. 2) One with perceptive deafness who has a social adequacy index of less than 10, can not expect to increase hearing with a hearing aid. 3) When the sscial adequacy index of deaf patients is between 10 and 33 and their deafness type is perceptive, then some of them can obtain a slight hearing improvement by the use of hearing aids.
To decide the efficiency of a hearing aid, the hearing loss of speech was less important than the articulation score and social adequacy index. The reasons are as follows: 1) The tereshold for speech, which is the null line of hearing loss of speech, is not constant and changeable according to the lists for the threshold test. 2) In order to ascertain the need for using a hearing aid, we must know the over-threshold hearing ability. Therefore the threshold of hearing is not needed for this purpose. 3) On the hard-hearing patients of high grade there is often difficulty to measure their hearing loss for speech.
The indication of a hearing aid was determined at first by speech audiometry in the free field on 47 cases and then the average hearing loss (C2+C3*2+C4/4 db) of the better ear was det- ermined. These values were compared with each other and a hearing aid was indicated by pure- tone audiometry as follows :
From the relation between the effectiveness of a hearing aid and the threshold curve of air conduction the following results were obtained: 1) In cases of conductive or mixed deafness it was difficult to decide the efficiency of a hearing aid by considering only the threshold curve of air conduction. 2) In some cases of perceptive deafness, the efficiency of a hearing aid was indicated by the air conduction curve. For instance : in the cases in which the air conduction curve shows a slow decline in the middle and high tone ranges, in which then the average hearing loss indicates 40∼55 db, the improvement of hea- ring with hearing aids can be expected; but in the cases where the air conduction curve indicates an abrupt fall in the high tone range, the use of a hearing aid will be of no avail.
Audiometries done for "Human Doek" patients showa the decreose of the hearing after 40 years of age. The decreose was mainly at 8, 000 cps and then 6, 000 cps and 4, 000 cps, showing "high tone slanting fall type". By the difference limen test, there was no marked difference between the aged and others. There was a remarkable high to hearing loss in aged group. Concluding alone evidences, it was thought the disorder was not due to the change in Corti's organ but of a central origin. C5 drop was rare in bresbycnsis. Since in those with C5 drop, the difference limen test was negative, it was thought that central factor might be related to the etiology of C5 drop.
In the study of audiometries of the female cottonmill workers, we found that the decrease of hearing was remarkable at 6000cps and 4000cps, 3000eps, 250cps order, and it became greater as the years of service increased. The hearing in each group of the different work was almost the same in those of one or two years of service, but that was more rcmarkable in the groups of first spinning (the noise being 90 100phon) than in the groups of second and finish spinning (the noise being 60 90 phon). By the difference limen test, many showed not only tee possible change in corti's organ but also the changes thought to be central origin. There was cleso C5 dip. We thought there might be central factor in volved in the etiology of C5 drop.