Of 100 patfents with chronic tonsillitis (37 patients of chronic tonsillitis without any complication and 63 patients with complications suspected tonsillar systemic diseases), electrocardiography was undertaken before and after tonsillectomy. Results obtained and summarized were as follows: The pathological E.C.G. findings were recognized in 35.0% of the Patients with chronic tonsillitis, of which 31.4% was improved after tonsillectomy. The percentage of the pathological E.C.G. findings in patients suspected some tonsillar complications were 50.9%, while in patients of chronic tonsillitis without any systemic complications, was merely 8.1%. In 34.4% of patients who had been suspected some tonsillar systemic diseases and that recognized some pathological E.C.G. findings, the electrocardiographic findings were improved within 1 week or 15 months after tonsillectomy.
Zweck meiner Untersuchung liegt auf der Bestimmung des normalen Horvermogens bei den japanischen Alten. Von 5028 Bewohner uber 60 Lebensjahren in Tozuka-Bezirk zu der Stadt Yokohama wurde 146 Versuchspersonen im Alter von 60 bis 86 Jahren gewahlt. Sie haben keinen otoskopischen pathologischen Befung und keine Anamnese der Larmschadigung. Ergebnisse. 1. Das Durchschrittsgehor des Horverlustes nur bei 4, 000 Hz bei Manner ist starker als bei Frauen. 2. Die Altersschwerharigkeit wurde in drei Gruppen unterschieden:, die phisiologische Presbyakusis" •ie essentielle Presbyakusis" und, , die sozialen Presbyakusis " Der Horverlust bei der essentiellen Presbyakusis ist progressiver und starker als bei der phisiologischen Presbyakusis. Die als die soziale Presbyakusis genannte Altersschwerhorigkeit zeigt den Steilabfall der Schwellenkurve im oberen Tonbereich und befindet sich meistens bei Manner. Die Ursache dieses Horverlustes ist nicht nur im Lebensalter, sondern im Larmgerausch, das wahrend des langen Lebensganges unbemerkt gelitten hat, zu suchen. Darum nenne ich diesen Horverlust, , die soziale Presbyakusis " 3. Das altersbedingte Horverlust steht in keinem Verhaltniss mit Blutdruck, Arteriosklerosis der Augenarterie und Serumgesamtcholesterin. 4. Im Sprachaudiogramm erscheint es wichtig die Feststellung, dass der Diskriminationsverlust des Alten grosser ist als des Jungen und die Steigerung inrer Kurve langsam ist. 5. Bei dem Alten, dessen Horverlust bei 1, 000Hz uber 30dB steigt, ist gross der Diskriminationsverlust und immer hat er die Klage der Schwerhorigkeit. Darum nenne ich diesen Horverlust, , die klinische pathologische Presbyakusis ".
Hearing test above the threshold has been experimented in various ways for differential diagnosis for so-called perceptive deafness. However, all the methods experimented so far have certain advantages as well as disadvantages. Therefore, a new method was experimented in the test above the threshold of hearing on one ear, clarifying the significance and fundamentals of the test. Method of the test: 1. The hearing-loss curve was prepared. 2. A sound of 20db. above the threshold was applied to a subject, the loudness being kept in his mind. 3. A point was seeked where the sound of the same frequency reached the same loudness of the sound mentioned in 2 above by increasing the former from 0db. 4. A point was seeked where the sound of the same frequency reached the same loudness of the sound mentioned in 2 above by decreasing the former from 90db. It was found, then, that some difference between the first point and the second point appeared for sounds of various frequencies. The distance between these points was taken as the result, Although modulations were carried out not only at 20db. above threshold but also at 40 db. and 60db above threshold, the results obtained at 20db. above threshold will be mainly explained in the following. Results of the test: The difference between the two points (hereafter referred to as the range of sensibility) was about 8 to 15db. for those whose hearing organ was ordinary as well as fot those of conduction deafness, while it was different for those of perceptive deafness. For instance, in Meniere's disease, the range was naraower. In central deafness, the range was wider. Most cases having positive recruitment phenomenon showed narrower range. These results indicated that the test had certain relations to the recruitment phenomenon. Following that indication, the test was experimented on animals with lesions of Corti's organs by giving a sound of various intensity to them only to ascertain the occurrence of recruitment phenomenon. Furthermore, in parallel to the test that sound stimulation caused the shift in the threshold of those with normal hearing ability, it was found that the range of sensibility of those with normal hearing ability got narrower after immediately after sound stimulation as the tone of sound became higher. The fact seemed to indicate that the test could be applied to ascertain a lesion in Corti's organ and the existence of recruitment. From the results mentioned above, it can be assumed that: (1) Cases showing narrower ranges indicate a lesion in Corti's orgarn. (2) Cases showing normal ranges have either a lesion in acoustic nerve, in variation of labyrinthine fluid, or lesions both in the acoustic center and. Corti's orgarn. (3) Cases showing wider ranges have lesions in the acoustic center. (4) This test above threshold is canbe applied to one ear in order to diagnosis of possible localization of lesions in percetive deafness.
Two groups of rabbits, one with diabetes mellitus deneloped by alloxan injection, and another healthy groups for the contrast were studied. In each group, middle ear infection was developed by staphylococcus aureus injection in tympanic bulla. The specimens of auditory organs were fixed in Wittmaack's solution, then embedded in celloidin and stained with hematoxylin-eosin. The results of the examination were as follows: In diabetes mellitus group, histopathological changes were more remarkable than that in contrast group on following points. 1) External auditory canal: Desquamation of the epithelium, celluler infilltration in subcutaneus tissue. 2) Tympanic cavity: Edema, celluler infiltration and bleeding in mucous membrane. 3) Bone absortion and Multiplication of tympanic cavity and tympanic bulla. 4) Periostal thickening, bone absorption in auditory ossicles. 5) Changes in inner ear were more remarkable and healing of inflammation was slower in diabetes mellitus group then in contrast group.
One of the controversial problems in the pneumatization study of chronic otitis media is sclerosis of the temporal bone. Regarding this problem we have assumed that sclerosis in chronic otitis media is not due to chronic inflammation of the mucous membrane, but to the individual constitution, based on our study which was carried out histologically. To clarify this problem we must make an observation of the temporal bone roentgenologically during the course of chronic otitis media. So far, this kind of observations has not been reported, because it is a very painstaking work. For this study the roentgenograms of 831 cases (1033 ears) were taken in Schueller's and Mayer's view. And in 45 cases (65 ears) the roentgenograms were taken two or three times in the intervals of one year to ten years. The results are as follow; Pneumatization of the temporal bone in chronic otitis media (including cholesteatomaotitis) was under-developed in 87.2% and well-developed in 12.8%. Attention must be directed to the fact that the well-developed cases were seen in high per centage in this study, because the incidence of the well developed temporal bone in chronic otitis media was low in the literatures. Pneumatization in cholesteatoma is underdeveloped in 91.5% of tympanal type and in 75.6% of epitympanal type. In the roentgenogroms of the temporal bones taken two or three times in the forementioned intervals, we could not find any change in these roentgenograms, namely any promoting sclerosis in the temporal bones in the course of chronic otitis media. Fortunately the roentgenograms of the temporal bones were taken in the two cases of young children of one year old and three years before the ocurrence of chronic otitis media during our study of the development of the air cells in the temporal bone. In these cases the roentgenological observations were repeated in the course of its chronic otitis media, but promotion of sclerosis of the temporal bones was not confirmed, while a mild development of pneumatization was found in one case. From these results it must be concluded that sclerosis of the temporal bone seen in chronic otitis media is under-development of pneumatization, not the consequence of inflammation of the pneumatic spaces.
Histological studies of 133 skin grafts in bulla ossea of rabbits were made as one of the fundomentaluts dies of tympanoplasty. The examination was done on 1st, 2nd, 3rd, 5th, 8th, 15th, and 30th postoperative day. The results were as follows: New epithelium was regenerated under the degenerated old grafts on 3rd and 5th. day. The epithelienr was thiekened after 8th day. Theepithelialization was disturbed by infection, excessive pressure, dryness and insufficient immobilization of the grafts. When mucus membrane was prsent, cyst formation was frequent and the grafts were scarcely taken, On the periosteum, the grefts were easily taken and epithelialization was safisfactory. On the bone without periosteum, the grafts were difficult to be taken and epithelialization was also disturbed. When the bone was injured prier to the graft, thick layer of granulation tissue was seen between the skin and bone. Regeneration of the bone was seen on 5th day but organization of the bore fissue was not seen even on 30th day. Thick grafts contained many hair follicles and sebaceous glands which became at rophied aad formed vacuoles later. There fore, thin grafts were thonght to be better than thick ones.
In order to know the cause why the amount of bleeding during sinus operation is remarkablly different from case to case, the author investigated the relation between the amount of the bleeding in maxillo-ethmoidectomy, systemic and local findings and anesthesia. In most cases examined, the systemic conditions such as bleeding time, coagulation time, prothrombin time, blood pressure and skin capillary wall resistance were proved to be normal and there was no significant relation to the amount of bleeding, while in few cases with abnormal values in the tests, bleeding was rather remarkable. Local conditions such as abundant blood supply to the area, and vascular dilatation and engorgement due to the severe inflammation were the effective causes of profuse bleeding. In anesthesia, precise blocking of maxillary nerve reduced the amount of bleeding, while general anesthesia (endotracheal anesthesia) increased the amount of bleeding, because of the dilatation of peripheral blood vessels. The amount of bleeding under potentiated narcosis was minimal, one of the main causes of which was the lowered blood pressure. In the author's investigation as mentioned above, it seemed that the amount of bleeding in each case was decided by the systemic and local conditions, the method enployed and skill in anesthesia in relation to one another.
A majority of chronic sinusitis cases are cases with polysinusitis and monosinusitis is rathes uncommon. It is said that in most cases of polysinusitis, the maxillary sinus and ethmoid sinus are simultaneously infected. Moreover, it is said that in many cases suppurative inflammation is seen in maxillary sinus, and so-called "polypose Veranderung", is seen in ethmoid sinus. Any detailed and systematic survey on these problemes had not yet been attempted. With a view to contributing to pathology of chronic sinusitis, the author examined both mucous membrane of maxillary sinus and that of ethmoid sinus in each of fifty cases of chronic sinusitis.
A considerable amount of research has been reported on the caloric test for the function of the horizontal semicircular canal, but little work has been done on the caloric test for those of the vertical semicircular canal. After a special surgical operation of the semicircular canal, the superior semicircular canal of rabbit was examined under various kinds of caloric stimuli by using the new apparatus which the author had made to give caloric stumulus to the semicircular canal. It was observed that severe vertical nystagmus appeared when the unilateral superior canal was stimulated and slight rotatory nystagmus appeared when the bilateral superior canal was done simultaneously. On the other hand when caloric stimulus was given to the unilateral superior semicircular canal, rotatory nystagmus appeared in man. Concerning with this reason the author presumed that it might be caused by the difference of anatomical situation of the semicircular canal and the eyeball between in men and in rabbits.
Electron microscopic and partially histochemical studies on the macula utriculi were conducted in the normal guinea pig. Several of main findings are as follows; 1) The otolith crystal consists of a number of the fine granules with high density. 2) Between the otolith crystals and under neath the otolith layer, there is colloidal substance which shows positive reaction to P.A.S. staining. 3) The sensory hair of a sensory cell consists of a kinocilium and 60-70 stereocilia, and these cilia end in the colloidal substance under neath the otoliths. 4) So called "Cuticle" of the sensory cell is reticular structure wnich is the basal part of the stereocilia and is composed of many fine fibers. The intracellular portion of the axial filaments of the stereocilia situate in the networts. 5) Near the surface of the sensory epithelium, there are well developped terminal bars, which surround the sensory and supporting cells and form the reticular membrane. 6) Two kinds of nerve endings are distinguished. Most of them belong to so called nerve calix, in which nerve fiber maks basket-like endings around the sensory cell. The other type is budshaped one.
An electromyographicalstudy of the intrinsic laryngeal muscles was performed in order to know their effect on the respiratory movements. And their innervation the denervation of the nerve which supplied to them. The results obtained were as follows. 1) The adductor muscles of the vocal cord contracted at the period of exspiration. During deep breathing their contraction was rather strong and the times of their discharge became longer. 2) The cricoarytenoideus posticus muscle was divided into two groups from the types of their contraction. One was A group in which, the muscle contracted at the period of inspiration. The other was B group in which it contracted at the period of exspiration. During deep breathing the contraction in A group increased and the time of its discharge became longer and the strong contraction in B group, which was supposed to be stimulated through other motor unit, was observed at the period of of inspiration. The following results were obtained by the experiments of denervation: 3) It was considered that the cricothyreoideus anterior muscle took its motor supply from the external branch of the superior laryngeal nerve. 4) The motor supply of the cricoarytenoideus lateralis muscle was from two nerves, namely the superior laryngeal nerve and the reccurent nerve. And it was reasonable to presume that the later nerve played as the main. 5) The transversus arytenoideus muscle took its motor supply from the bilateral reccurent nerves. The nerve supply of the superior laryngeal nerve to this muscle did not been proved. 6) M. vocalis was considered to be supplied from the reccurent nerve. 7) It was considered that the cricoarytenoideus posticus muscle took its motor supply from the reccurent nerve.
Generally the mucous membrane of inferior nasal concha consists of abundant vegetative nerve fibres and some sensory nerve fibres, and both participate in the plexus formation of deep and superficial lamina propria. In addition to this, intervenous nerve plexus in cavernous plexus and periarterial plexus around arteries were often observed. Vegetative nerve fibres form their fine terminal reticula around arteries, cavernous plexus and nasal glands; that is, vegetative nerve fibres, turn to preterminal fibres which are vacuolar, reticular or fascicular in shape when stained, and reach the wall of ducts and glands. Then the fibres, divided into finer neurofitrils, penetrate in to adventitia, some of them into intermediate coat of arteries, and form fine terminal reticulum chiefly around smooth muscles. The preterminal fibres which reached a glandular wall, wrap it like a basket and form terminal reticulum around the glandular acini. No vegetative nerve fibres which enter epithelium are found at all. Sensory nerve fibres are few, and most of them generally lose their myelin sheath earlier than those in other mucosa. The type of nerve endings is mostly simple branched ending; compound branhed or unbranched endings are few, and corpuscular endings can not be found. Different from other mucous membrane, nerve endings are often found in the connective tissue of lamina propria. Fibres in epithelium are rarely found. They are much finer and tneir endings are sharp. On the base of these findings I made a comparative study of reports of the investigators from the histological view, and examined the function of inferior concha mucosa from the neurohistological standpoint. Moreover, a suggestion was made that vegetative nerve fibres, with arteries, plays an important role in the developnent of chronic sinusitis.
There has been many studies done about nasal troubles of dental origin. Howevre, there has been no report about the dental diseases of nasal origin. Five cases in which dental and nasal lesions were noted, were reported and following conclusions were made after a careful study of symptoms, clinical course, morphology and X-ray findings from the stand point of rhinology and dentistry. 1. Dental disease of nasal origin appears unilaterally. Acute flareups or infection of chronic sinusitis or septal disease are counted for the cause of the disease. 2. Percussion of the affected tooth reveals pain similar to that in simple pulpitis and it is improved by rhinological treatment. Periodontitis, gingival abscess, palatine abscess and etc. are counted for the cause of the disease. Furthermore, the teeth ar not decayed and the clinical course and prognosis are better than that of decayed teeth. 3. Though it starts with rhinological symptoms, when the teeth are affected, pain becomes a chief complaint and rhinological lesions are often overlooked. The disease should be treated from the stand point of both rhinology and dentistry.
There has been no discussion about the relation between palatine tonsillar lesions and decayed teeth. Nine hundred and sixty-three cases were examined and relation between tonsillar lesions such as inflammatory or physiological hypertrophy, and dental lesions such as decayed teeth or gingivitis were studied. The patients selected were between 12 and 14 years of age. Conclusions were as follows: 1. There was close relationship between inflammatory hypertrophy of the palatine tonsils and apicitis of the teeth and gingivitis. 2. There was no relation between the side of tonsillar lesion and that of detal lesion. 3. There was relation between the severity of the dental lesions and tonsillar lesions in order of grade I, grade II hypertrophy after Mackenzie and burried type lesion. 4. Since the disease is on the border line of the two fields of medicine, further studies by the otorhinolaryngologists and dentists should be made.
1) The author discussed the tonality of tinnitus aurium, making the patient compare it with pure tone of audiometer at the intensity of 5-10db and indicate its frequencies and onomatop. The complaints of tinnitus indicating high tone, high frequencies like "chirping of cicada" or similar tones were the most frequent through the cases of all kinds of deafness and normal haring. But such tinnitus was complained the most frequently by the cases of perceptive deafness. The cases of conductive deafness did not complaine so often. The latter complained rather more it of middle frequencies. The cases of normal hearing and mixed deafness were situated among them. 2) Between onomatop or metaphorical expression of tinnitus and the indicated audiometric freque ncies, there was a close relation. While the patients who indicated the low frequencies in 125-250cps about their tinnitus expressed it by onomatop with syllables ending in "u" or "o", those who indicated the high frequencies in 3000-8000cpse xpressed with those ending in "i" This relation was affirmed also by an experiment, making normaly hearing, conductively or perceptively deafend persons hear the audiometric tones and express them with onomatop. Next I observed onomatop of tinnitus by the sound spectrogram. It gave the results that the tones are concerned to high frequencies. Therefore I can presume, to some extent, the kind of deafness from the tonality of its tinnitus. 3) Some cases show 2 or more different kinds of tinnitus in one same ear and sometimes different kind of it in each ear on one case. This suggests that tinnitus is origianted from many different sources. 4) About the frequencies and onomatop of so-called subaudible tinnitus was recognized almost the same as above mentioned. This makes it supposed that the so-called subaudible tinnitus has a close relation the ordinary tinnitus. 5) Frequencies which were indicated as those of tinnitus, were relatively similar to deafend frequencies throughout on both cases of perceptive and conductive deafness by means of audiograms. Perceptive deafness with tinnitus showed almost types of high tone deafness, but on the cases of conductive deafness it was not so constant as on those of the former.
Purpose of the Study: Proetz's method for the displacement of the entire paranasal sinuses is highly appraised for its practical value in the diagnosis and treatment of paranasal sinusitis. It requires, however, a special instrument. lt also requires practice in synchronizing the aspiration and the up-lifting of the soft palate. Moreover, it is mainly the posterior group of paranasal sinuses which can be displaced by Proetz's original method and the anterior group is rather difficult to be displaced. In order to mitigate the above inconveniences we devised a modification of Proetz's method. In our method, by means of forced inhalation, the problems of the instrument and the synchronization were solved, and by adopting two step positional change of the head, the displacement of the anterior group was facilitated. Method: From the head position in which the connecting line between the chin and the external meatus is vertical the head is rotated more than 90° towards the side to be displaced (the first position). Then the head is returned to the original position. Next the head is over extended so that the connecting line between the Adam's apgle and the enternal meatus becomes vertical (the second position). In each position the patient is requested to repeat forced inhalation (rapid and strong inhalational action with the mouth and nose closed) to create a negative pressure(-40--50 mmHg) in the nasal cavity so that a previously instilled drug is displaced. Conclusion: By our method, when compared with Proetz's original method. the displacement of the anterior group becomes easie. It a1so enables simultaneous displacement of the entire sinurses. The practical value of our modified method was confirmed not only as a diagnostic method but also as a treatment of paranasal sinusitis in chidren.