Aiming to resolve the problem on sensation of the nasal mucosa, the anterior part of the inferior turbinate was stimulated with rectangular pulse generated from an electrostimulator, and the subjective threshold of intensity (volt) and the objective observation with GSR were measured in normal, sinusitis, atrophic rhinitis, hypertrophic rhinitis etc. A silver-wire of 0. 4mm in diameter, the end of which was covered by a cotton-ball soaked with normal saline solution, was used as an electrode, and a silver-plate of 55×100mm was applied to the wrist as the indifferent pole. Sensation of prick, pain or touch were produced by electric stimulation. The threshold in simple atrophic rhinitis was the lowest, and that in hypertrophic rhinitis was the highest: the thicker the turbinate, the higher was the threshold. Neuro-histological changes were investigated by means of Bielschowsky-Suzuki's silver impregnation at the same time. The mucosa was innervated abundantly by considerable fine nerve-fibers of myelinated and fine whose myeline-sheath were lost which were ramifying in plexiform. Most of them terminated freely in every layer of the mucose, but some in terminal bodies were seen only in the vascular layer. Normal density of nerve-endings was confirmed in normal cases and simple atrophic rhinitis. Rather low density was seen in hypertrophic rhinitis but was normal in turbinal hypertrophy due to cavernous tissues. The density in genuine atrophihic rhinitis varies according to the grade of pathologic process. Sensory nerve-endings were preserved well in the turbinal tissue of simple chronic inflammation, but lessened or absent in that of degenerative and destructive inflammation, and higher threshold in the latter was obtained. Such findings were confirmed in Wegener's granulomatosis. Generally, nerve-fibers show more resistance than other tissues against these pathologic process. In cases of nerve-injury due to invasion of tumors, the threshold rose abnormally high, and revealed at times insensitivity. It is concluded that threshold-shift depends on the distance between the electrode and nerveendings, the grade of pathologic changes of nerve-fibers, and on mucosa such as epithelial metaplasia and fibrosis.
Absorption of Gelfoam and Spongel, inserted in to the tympanic cavity were discussed in tympanoplasty. This study was undertaken to investigate its relationship with the pneumatisations theory. As experimental animals, pigs and rabbits were used, because the tympanic cavity and mastoidcells of the pigs are well-developed similar to human mastoidcells and the middle ear of the rabbit is constructed as simple antrum, which is called a bulla similar to the under-developed pneumatic cavity. Gelfoam and Spongel were inserted in these cavityies and from ten to fourty days later histological observations were done postoperatively. In the mastoidcells and tympanic cavities of the pigs no remains of Gelfoam were seen, but histologically the homogenous or fibrous gelatin materials stained by eosin were found and inflammatory reaction of the mastoidcells was remarkable. In the cavities of the mastoidcells the small round cells, histiocytes, plasma cells, leucocytes and flat epithel cells were revealed, in which phagocytic functions was noted. The mucous membrane was thickened and oedematous. The small round cells and histiocytes were extensively infiltrated. The tympanic cavity showed a similar reaction with mastoidcells, except a fibrous proliferation of its mucous membrane. In the middle ear of the pigs, the remains of the Spongel were found from ten days to twenty days after the operation. But after the fourty days, no Spongel was found, but the mucous menbrane was oedematously thickened. In the bulla of the rabbit, the Spongel was seen after fourty days and the reaction of the bulla membrane was slight. As control these materials were inserted in to the mucous membrane and skeletal muscles of the rabbits and histologically observed. From this experiment, it was concluded that the Spongel tanpon inserted in the well-developed middle ear might be easily absorbable but in under-developed state absorption was very slight.
In order to estabish a method of audiometry, the author diviced an acoustic instrument (AR-meter) for detecting the intra-aural muscle reflex evoked by acoustic stimuli and studied its clinical application. The blockdiagram of this device is as shown in Fig. 1. A pure tone generated by a small earphone is sent to the external auditory canal to produce a constant sound pressure in it. Sound pressure variation of the test tone is brought about by displacement of the tympanic membrane when the intra-aural muscle reflex is evoked. This variation is picked up by a probe tube microphone, amplified through an amplifier with a balance circuit, and finally indicated by a voltmeter. The results are as follows. 1) The carrier tones of 500 to 6000c.p.s. is found most available, because these tones show stable sound variation. 2) The threshold of aural reflex is 65 to 90db S.L. in a frequency range of 500 to 4000c.p.s. in different person. 3) The stimulating tones of 1000 to 2000c.p.s. is found most effective for eliciting the aural reflex. 4) Objective audiometry by the author's AR meter is found applicable for adults and children. 5) Aural reflex can not be detected by AR meter especially in cases with facial palsy. 6) Recruitment of loudness can be measured by AR meter in nerve deafness with loss of less than 60db. 7) It is concluded from the results of the patient of facial palsy and the other experients that the action of stapedius muscle for the tympanic menbrane is greater than that of tensor muscle.
Sinuectomy is devised as a permanent cure of chronic sinusitis preventing its recurrence. Many various procedures have been reported, but an ideal procedure which accomplishes this aim of sinuectomy has not yet published. In this paper, at first, the concept of cure and recurrence in the chronic sinusitis after sinuectomy were discussed. The author's idea in regard to the fundamental principle of sinuectomy was then stated. Sinuectomy was considered as sinoplasty, or reconstruction of sinus, because sinuses in polysinuitis was reconstructed into the following manner. The mucous membrane of the sinuses was detached completely and the septums between the sinuses taken off, so that the sinuses were changed into a narrow single cavity, in which the ethmoidal sinus was situated in the center. To keep the communication between the ethmoidal sinus and the nasal sinus a wide cleft was made in the posterior part of the middle nasal concha. The opening in the middle nasal meatus was made in the usual manner. Moreover in oder to make an effective drainage of the ethmoidal sinus into the inferior nasal meatus, the following two procedures were performed, namely osteoplasty of the anterior wall of the maxillary sinus and grafting of the detached mucous membrane of the maxillary sinus on the floor of the maxillary sinus, extending bejond the border between the ethmoidal sinus and the maxillary sinus. However, proliferated submucous tissues should be removed from the membrane before grafting.
Bekesy audiograms were compared between tracings with continous and interrupted tonal stimulations. In accordance with Jerger, reduced amplitude in Bekesy tracings in cases with cochlear lesion were observed exclusively when the test was administered with continous tone, but this change was not recognized in the test with interrupted tone. On the basis of this fact, the authors came to the conclusion that the amplitude reduction in Bekesy audiograms observed in the ears with perceptive deafness must be considered as a representation of abnormal adaptation, not of loudness recruitment.
The author described a testing procedure utilizing the auditory startle response as the index of hearing. Four speakers were equipped at the four corners of the testing cubicle, and the artificial animal sounds were used as the test sounds. The most important responses observed in the examinees were found to be (1) movements of the eyeballs and (2) turning of the head toward the source of the auditory stimulation. It is noteworthy that the responses are evoked at the intensity level of the testing sound very close to the subjective threshold of the examinees; the average difference between both thresholds being only 4.2db. The author believes that the startle response audiometry is a reliable means of measuring the degree of auditory impairment expressed in threshold value for infants above three months of age. Pure tone, pulse tone and filtered social sounds were used in the test, revealing the fact that these fractionized sounds are less suitable for the test material in the startle response audiometry.
Postapoplectic development of unilateral facial nerve palsy and paralysis of the contralateral upper and lower extremities were observed in two, 47 years old and 50 years-old brothers. Angiographically, the diagnosis of thrombus formation in either posterior inferior or anterior inferior cerebellar artery was established. Otologically examined, both of them were noted to have Bruns's nystagmus, the larger nystagmus of which was directed to the side of facial nerve palsy. It is interesting that Bruns's nystagmus, which had been generally considered to be characteristic. to cerebellopontine angle tumor, occured following an attack of cerebellar apoplexy. We have recommended postural nystagmus test for the purpose of early discovery and differential diagnosis of circulatory disturbances in brain. The importance of Bruns's nystagmus is to be emphasized for the same purpose.