The results of 116 cases of the shock in the Otorhinolaryngological field observed in 58 large hospitals of Japan, were studied statistically and the following conclusions were obtained. (1) Most of the shock in the Otorhinolaryngological field were related to the administration of local anesthetics befor operation and most of them appeared within 5min. after administration of local anesthetics. (2) Death rate of the shock was less in the nasal manipulation than in other Otorhinolaryngological regions. (3) Shock cases were classified into 5 types on the basis of clinical findings; Type I Severe case (Convulsion Form) Light case (Shibire Form)=Type V Extremely (Numbness) Type II Rapid Syncope Form Type III Pale Syncope Form Type IV Respiratory Syncope Form Convulsion-form (Type I) was seen most frequently in our clinics and showed high fatality, so clinically it is the most fearful type of the shock. On the contrary numbness form (Type V) is the least dangerous of all. (4) Some correlation between age and shock type was found. That is, convulsion form was often seen in the case of children under 10 years old and numbness form was often seen in the one and two decades. In the age over 50 years old, pale syncope form and respiratory syncope form were more frequently found. (5) The different types of local anesthetics had no counection with the shock types. (6) Abnormal diathesis (e.g. allergic diathesis) was found to be the chief disposition of the shock and should be thoroughly checked before administration of anesthetics.
The appearance of nonconditioned GSR to pure tone stimuli and its evaluation to the practical application in objective audiometry was studied. Endosomatic method was used for measuring the GSR, and all responses were recorded graphically. The results were as follows.: 1. Galvanic adaptation to repeated pure tone stimuli took place rapidly. a) As auditory stimuli, 1000cps pure tone at 80db were presented. Among three groups of which time interval of stimuli were 20sec., 40sec., and 1 minut. respectively, it seemed that galvanic adaptation tended to appear more slowly as time interval became longer, however, there was no statistically significant correlation. b) As auditory stimuli, 1000cps pure tone were presented at 20sec. interval of stimuls. Among four groups of which intensity of stimuli were 10-20db, 30-40db, 50-60db and 80db respectively, a relationship was not established between the rapidity of galvanic adaptation and the intensity of stimuli. 2. Nonconditioned GSR to pure tones was very unstable and different individually, however, if a subject concentrated his attention on the test tone, his GSR became stable, and its threshold value obtained with GSR was markedly lowered. Subjects were previously instructed to count the number of times that he could hear test tone, in order to concentrate his attentation on test stimuli. 3. Threshold determination with GSR audiometry were performed on 71 subjects by means of the method mentioned above. As test tones, 500cps, 1000cps, 2000cps, and 4000 cps pure tones were used in 10db step ascending method. GSR andiometry proved possible for 59 cases out of 71 subjects, and 90% of the threshold value of obtained with GSR audiometry was distributed within ±10db with those obtained in standard audiometry. 4. This audiometric method was difficult to apply in the measurement of hearing acuity of young children under 4 years of age.
Eight cases of bilateral immobilization of the vocal cords in median position were reported. This condition is also known as bilateral abductor or posticus paralysis. However, it should be noted that the term of median immobilization is most preferable, because it describes laryngoscopic findings fully. The cords may be immobilized by various factors; paralysis of the laryngeal nerves, arthritic fixation of the cricoarytenoid joints and so on. No information on the cause of immobilization can be obtaind by mere inspection of the larynx. The differential diagnosis must be made by palpation of the arytenoids (passive mobility test) and by electromyographic examination of the intrinsic laryngeal muscles. It is usually said that operation for goiter is the most frequent cause. However, seven of the eight cases are etiologically unknown and the other one was caused by laryngeal trauma. Of 44 cases of the bilateral immobilization reported in this country (including our cases), twelve are etiologically unknown. Next to this, comes laryngeal trauma. In three of our cases, respiratory function test and phonetical test were made before and after the extralaryngeal laterofixation of the vocal cords. These tests were found to be very important for evaluating the patient's ability of breathing and speech.
Seven cases of the chronic sinusitis, which had undergone antrum-window-operation 1.5-10 years ago, were reoperated. At these operations the status of the antrum-window in the inferior nasal meatus and the mucosa of the maxillary sinus were examined and the following results were found. 1) The antrum window was closed in 3 cases (5 sides) among 11 cases and remained open in 4 cases (6 sides). 2) In the cases with closed window retention of secretion and severe swelling of the mucosa were observed in the maxillary sinus. The maxillary sinuses with the open window were empty and the swelling of the mucosa was slight. 3) The mucosa of the ethmoidal sinus of the closed cases revealed remarkable swelling which was not found in the open cases. From these results the author concluded that the severe change in the mucosa of the maxillary sinus could not be reversed by antrum-window-operation. The fact that the closed cases are associated with severe ethmoiditis suggest that this type of operation is not indicated in those cases complicated with severe ethmoiditis.
Die Wirkung des Augenschliessens und der Kopfrechnung auf Nystagmus wurde von uns untersucht. Während der horizontaler pendelartiger Drehbewegung (Amp. 45 Period 5"), in normalen Fällen und derartigen mit zentraler Schädigung, Nystagmus wird durch der Augenschliessen gehemmt und these Hemmung tritt bei gleichzeitigen Kopfrechnung zurück. Die Augenschliessen vergrössert den Kalorischen Nystagmus mehr in normalen Fällen und derartigen mit peripheren vestibulären Schädigungen, aber verkleinert in deren mit der zentraler Schädigungen. Spontan-und Lage-Nystagmus wird durch Augenschliessen gehemmt, bei zentraler Schädigungen (Z. B. Hirn Tumoren) aber nicht bei peripherer Schädigungen (Z. B. Ménièresche Krankheiten). Gehemmter Nystagmus durch Augenschliessen erscheint bei Kopfrechnung ziemlich deutlich zu sein. Diese data gelten, um dem Herd, zentral oder peripher, zu diagnostieren.
Primary cancer of the sphenoid sinus is rare, and even if tumors are found in the sphenoid sinus, they are mostly those from the epipharynx or other nasal sinuses. In this report, one case of primary cancer of the sphenoid sinus was described. The patient was 71 years old female, whose chief complaints were blepharoptosis, visual disturbance of her right eye, and tumors on her right neck, Other clinical symptoms were headache, right otalgia and motor disturbance of all muscles of right eye. No other nasal symptom than bleeding was observed. A small papillate and polypoid tumor was found in the olfactory cleft by anterior rhinoscopy, but not by posterior rhinos copy. It was revealed by operation that this had originated from the sphenoid sinus, destroyed the Turkish saddle, pushed to the dura mater, and infiltrated to the pterygopalatine fossa and the submucosa of nasopharyngeal cavity. Histological examination showed that this tumor was squamous cell carcinoma of papillary structure. Distinctive features in this case was the initial headache, and the only nasal symptom was bleeding which appeared in the last stage. Eye symptoms such as motor disturbance of all muscles of the eye and visual disturbance were also conspicuous.
Hearing acuity of 420 normal children aged under 4 years was measured by means of COR-audiometry. The rate of successful test in each age group was as follows: under 1yr. 39.4 per cent 1yr. to 1yr. 5mo. 79.4 1yr. 6mo. to 1yr. 11mo. 86.8 2yr. to 2yr. 5mo. 81.6 2yr. 6mo. to 2yr. 11mo. 91.9 3yr. to 4yr. 64.0 By using the modified method introduced by Ogiba, this rate of successful test was increased to 83.3 per cent for infants 8 to 11 months of age. Consequently, the majority of the tests for infant children under 1 year of age were administered by using Ogiba's modified method. Average hearing threshold in each age group of each 50 examinees is indicated in the following table. under 1yr. 27.4db 1yr. to 1yr. 5mo. 20.3 1yr. 6mo. to 1yr. 11mo. 16.2 2yr. to 2yr. 5mo. 13.7 2yr. 6mo. to 2yr. 11mo. 12.6 The tendency of the hearing acuity of small children to get closer to 0db as the child becomes older was clearly seen. Comparison of the hearing thresholds obtained in the first and the second tests revealed the fact that the difference between the two thresholds fell within the limit of 5db in 90.2 per cent of the total examinees tested. Age difference in the test-retest variance was not recognized.