The author have studied in 274 cases with posttraumatic vertigo from the observation of optokinetic and vestibular nystagmic reaction. The results obtained are summarized as follows; 1) Of the total 274 cases, the spontaneous nystagmus was observed in 138 cases (49%) and the positional nystagmus in 190 (69%). 2) Pathological findings of optokinetic nystagmus, for example, optokinetic inversion, inhibition or interruption of optokinetic nystagmus, hyperexcitability of optokinetic secondary phase, dissociation between the direction of optokinetic and vestibular DP, were highly observed in patients in cases with the central damage. Therefore, the test of optokinetic nystagmus is of vital importance for differentiation of posttraumatic vertigo. 3) By the test for torsion or extension of the neck, nystagmus was frequently provoked especially in cases with central damage, therefore, this test is of vital importance for the diagnosis of posttraumatic cervical syndrome. 4) To speak the singularity of posttraumatic vertigo, the following will be mentioned. (1) The determination for the localisation of the lesions is usually difficult. (2) Most of these cases have no neurological findings. (3) Pathological nystagmic reaction was only observed in cases of the brain-stem lesions. (4) Symptoms and nystagmic reaction are unsettled for long period of time.
The author discussed on the formation mechanism of so-called cyst which was frequntly found in the mucous membrane of chronic otitis media or granulation of epidermization difficulty of post operative mastoid wound in histology. Results were as follows; 1. There were many grades of so-called cyst formation from the “Hollow” of “epithelium” or “Tasche in germany” to looked like cyst in reality. 2. From the point of view formation mechanism of so-called cyst was classified into next 4 groups. Type I. was formed by the hollow of epithelium. Type II. was formed by adhaesion or juncti. on of epithelium which had pappillary processus extended as far as opposite epithelium. Type III. was formed by adhaesion or junction of tow chnged in the papillary epitheliim. Type IV. was formeg by epithelium and regenerated mastoid cells. 3. So-called cyst was formed in the mucous membrane with marked inflamation. 4. So-called cyst depended on the middle ear pneumatizations grade, and it is apt to rise from the well-developed mastoid cavity.
During the 6 months period from Oct. 1965 to March 1966 in the department of Oto-Rhino-Laryngology, School of Medicine, Gunma University, we encountered 58 cases diagnosed as sulcus Vocalis, which is a groove in the vocal cord running parallel with its free edge. We examined and statistically discussed these cases mainly from the view of its clinical aspects and observed the following results. Incidence of the sulcus Vocalis in our clinic showed approximately 13% among the patients complaining of laryngeal problems. The cases with the sulcus Vocalis were found in the patients suffering from chronic laryngitis (25 cases), vocal cord polyp (23), recurrens paresis (4), laryngeal neurosis (2) and laryngeal tumor (2). The results concerning about sex incidence, age at onset and other clinical signs and symptome were discribed. The local findings about sulcus Vocalis showed that its groove is variable in length and depth, and that its localization is in various ways, namely it was observed as a groove on only one side of the vocal cord in the some patients (23 cases) and on the both sides in the others (58 cases). Moreover, we discribed about the pathohistological findings of the sulcus Vocalis and discussee about its etiology from viewpoints of our observations and the literatures.
Auditory nerve action potentials in man to click stimuli could be obtained easily and nonsurgically from the external auditory meatus by means of an average response computer. The configurations of the responses are quite similar to those of the surgical approach reported by Ruben et al, Bordley et al, and Ronis. The present findings of the latency, the input-output relation, and the recovery function of the AP in man, at least in part, seem to fit in better with the studies on those of animal experiments by Derbyshire and Davis, Davis, Rosenblith, and others. The significance of this nonsurgical recording is that a new field of objective audiometry will be opened by the neurophysiological responses of the ear. The present study of normal subjects has shown the followings: 1) A typical tracing of the response to clicks of moderate strength is a negative wave, “N1”, followed by a smaller second negative wave, “N2” and then occasionally a third still smaller negative wave, “N3”. 2) The latency of N1 is a function of the click intensity. 3) The input-output function of N1 shows two fairly distinct slopes of the growth, a small one with low threshold and a larger one with higher threshold. 4) The AP to clicks is masked by simultaneous stimulation of a white noise. 5) The recovery function of N1 shows an asymptotic approach to the full recovery. Further works on the AP in man is necessary to evaluate the degree of impairment hearing in adults and children from the observations on the presence or the absence of the response, and to obtains diagnostic information on sensory-neural defects or subtractive loss.
1. The endolymphatic sac was destroyed and obliterated by an extradural approach in 31 ears of guinea-pigs. A complete obliteration was confirmed by the histological examination in nine of them, which were 24 hours to 53 days postoperative. Endolymphatic hydrops developed as early as 24 hours after the operation and was slowly progressive thereafter, causing flattening or compression of the organ of Corti in two postoperative weeks. The hydrops was interpreted as a “retention hydrops” due to the interrupted resorption of endolymph. Thus, in contrast to the inconsistent results of the former works concerned, the present experiment clearly demonstrated the inevitability of the endolymphatic sac as a resorptive organ of endolymph. 2. Sodium and potassium concentration of endolymph and perilymph was measured by using atomic absorption spectrophotometer in 73 ears of guinea-pigs, which were 24 hours to one month postoperative of the obliteration operation of the endolymphatic sac. In comparison with the non-obliterated ears, potassium increased in endolymph and vestibular perilymph but decreased in scala tympani perilymph, while sodium decreased in vestibular perilymph but not significantly changed in endolymph and scala tympani perilymph. It was clarified by the experiment that the “retention hydrops” was an entity associated with the electrolyte (Na, K) changes in the inner ear fluid. 3. An obliteration operation of the perilymphatic duct was performed in 26 ears of guinea-pigs by an intradural approach. A complete obliteration was histologically confirmed in only four ears of them, which were 48 hours to 13 days postoperative. The findings characterized by the buldging of Reissner's membrane and the nubecular precipitate in the perilymphatic space without compression of the organ of Corti, were interpreted in terms of the “ passive endolymphatic hydrops ” due to the interrupted supply of perilymph. A conclusion was drawn that the perilymphatic duct was an important supply route of perilymph from the subarachnoid space.
The properdin system is a serologic protective system which contribute to natural resistance and does not belong to cellular protective system. The properdin titers were measured in order to explain the significance on every pathologic form of chronic tonsillitis, especially on the influence of properdin upon the mechanism of tonsillar focal infection. The method of the Zymosan assay modified by McNall was used. Average values of the serum properdin titer in the patients with focal chronic tonsillitis showed 77.1 units. These were lower than the 89.3 units in the patients with simple chronic tonsillitis and the 90.4 units in a control group of healthy persons. Those with rheumatic disease especially showed 74.6 units which was the lowest among the systemic diseases. In a focal group low values of the serum properdin (under the lowest of the serem properdin titers in a control group, 60 units) were seen in 31.8%, while 9.5% in a simple group. Low values in serum properdin were found more frequently in patients who showed an increase in Antistreptolysin-O titer and the properdin values in focal group were lower than those in the simple group. This is supposed that streptococcal infection gives the impeded effect to individual resistance. After focal elimination by tonsillectomy, the serum properdin remained much the same value as before tonsillectomy in both simple group and non-focal disease with chronic tonsillitis. But in the focal group, the serum properdin increased close to the nomal level and its value was in parallel with the degree of the recovery from systemic disease. Results from cutaneous injection made with the diagnosis solution of Paspat, focal group showed frequently an increase of serum properdin in coopration with reduced erythemata after tonsillectomy, while the simple group did not show these variations due to removal of tonsil. This increase of properdin suggests a recovery of natural resistance, because the patients became to possess no allergic aggresion on basis of bacterial infection. The properdin titers were varied in tonsillar nephritis, after tonsillar direct irradiation by ultrashort wave was given, and the titer in tonsillar rheumatic disease increased, after tonsillar focus was annuled by Impletol injection. From these results, it was attested that the tonsillar focus had the influence upon natural immunity and suggested that the properdin system had some roles in the mechanism of the tonsillar focal infection. Therefore the measurement of the properdin value has the effects to infer the immune stadium in the basis of the focal infection.
Electromyographic investigations of the intrinsic laryngeal muscles were carried out in 29 human cases with recurrent laryngeal nerve paralysis and in 14 canine cases, in which unilateral recurrent laryngeal nerve paralysis was experimentally caused by various methods of crushing, section and suture after section of the nerve. The observations in dogs were repeated before the operation and several minutes, several days, a month and every months up to death after causing paralysis. The laryngoscopic view of the position of the vocal cords was compared with the electromyogram in every case. The results obtained are as follows; 1. The thyroarytenoid, the lateral cricoarytenoid and the posterior cricoarytenoid muscle of the human larynx are innervated by homolateral laryngeal nerve, and the arytenoid muscle is innervated by bilateral ones. In the canine larynx, however, the arytenoid muscle is separated into two pieces in both sides and innervated by each homolateral recurrent nerve. Some muscle fibers of the cricothyroid is considered to be mixed in the lateral cricoarytenoid in dogs, because the electrical activity of the lateral cricoarytenoid was not ceased after section of the homolateral recurrent laryngeal nerve in some of canine cases. 2. The abnormal pattern of electromyogram of laryngeal muscles such as fibrillation voltage, complex NMU voltage or reinnervation voltage was observed in many cases of recurrent laryngeal nerve paralysis. In the course of regeneration of the nerve in canine cases the fibrillation voltage appeared within 5 days after the damage of the recurrent laryngeal nerve and subsequently the complex NMU voltage was developed and it was followed with the reinnervation voltage and the normal NMU voltage. 3. No differences among regeneration velocities of the intrinsic laryngeal muscles were noted in the experimental recurrent laryngeal nerve paralysis of dogs. The nerve regeneration velocity is sooner as following order, crushing-group, suture after section-group and section-group. 4. The phenomenon of the misdirected regeneration of the nerve was noted in some cases of both human and canine recurrent laryngeal nerve paralysis; i.e., active discharges of the adductor or the abductor of the vocal, cord were recorded during inspiration and expiration as well as phonation. Since the abductor contracts with the adductors during phonation and respiration after. the nerve has regenerated, the involved vocal cord remains to be fixed at paramedian position in some cases of recurrent laryngeal nerve paralysis. 5. Electromyographic analysis of all intrinsic laryngeal muscles in cases of so-called musclar palsy such as "Internus palsy" or "Transversus palsy" revealed no abnormality of the function in these muscles. It is considered the insufficiency of closure of the glotttis during phonation is caused by the pathological change of the mucous membrane in the subglottic cavity.
To study on the influence of the autonomic nerve system as regards the raising of systemic disease by focal infection, an experiment on rabbits was conducted as follows. A comparative study was histologically, made in the kidney, heart, liver, spleen and adrenal glands, what influence the autonomic nerve irregularity, added at the same time as the reinjection of antigen substance, has upon raising allergic disease in the distant organ and also to investigate the operation of the autonomic nerve system focal infectional systemic diseas, to make use of rabbits which had been subjected to prolonged sensitization injected the streptococcus to aseptic abscess. Antigen-antibody-reaction did not lead by itself to organic pathologic alteration of the organ, and only a swelling and hyperaemia of the glomerule at the kidney was observed, but slight degenerative signs were found in the rabbits bred in. 0-4°C. No purposeful result was obtained in the group injected with medicine to act on the general autonomic nerve at the same time as the antigen reinjection. In the group injected with crotonoil into the tissue of the soft palate before the antigen reinjection to the sensitized rabbits, a remarkable reactive and organic change was noted on all organs that were more intense than group of 1) crotonoil injection, 2) prolonged sensitization and crotonoil injection, 3) crotonoil injection and antibody injection. On the kidney, swelling, hyperaemia and degeneration were appeared in the glomerule and the tubule, and these changes were became worse by the progressing of the date. In the cases proceeded 12 days after the injection of the antigen, atrophic collapse of the glomerule, diffus intensitive degeneration of the tubular epithelial layer and degeneration or disappear of the nucleus partially. That may be explained by the fact the antibody of the organ, acquired by prolonged sensitization, reacted with the reinjected antigen, and the crotonil injective stimulus promoted the raise of organic pathologic alteration. For that reason, the disease raising factor of the autonomic nerve was inferred and the accele-ration of capillary reactivity, caused by irritation of the direct autonomic nerve stimulus, constitute the required condition for raising the allergic alteration of organs with reticuloendothelial hypofunction and etc., and was described about the importance of chronic tonsillitis on focal infection in the same causes.
Since Dix at al. (1948) reported that loudness recruitment was characteristically present in endorgan (cochlear) hearing loss and characteristically absent in hearing loss associated with VIIIth nerve tumors, further studies have been made by many investigators concerning recruitment test. In 1959 Jerger et al. introduced the SISI-test, which they described simply as a test of differential intensity sensitivity, and SISI is not an indirect test for loudness recruitment but a way of telling whether the patient can hear very small changes in sound intensity. Evidence exists that the ability to bear these very small changes are unique to disorders of the cochlea. Yet the results of many workers have not reached agreement because of discrepancy in the testing procedures and its criteria. So in this study the SISI-test was given to 10 subjects with normal hearing, 72 patients with cochlear lesion, and three patients with VIIIth nerve tumor (Neurinoma) using from 500 to 8000Hz as the test frequencies. On the other hand, the results of the recruitment test by Bekesy audiometry were compared with that SISI-test on these subjects, and the following conclusions were drawn: 1) The SISI scores of the subjects with normal hearing were 0 to 5 per cent with the test condition at sensation level of 10dB and intensity increment of one dB. As for the test condition, there is no significant difference in the SISI score between 10dB SL and 20dB SL, however, it is necessary to set the intensity increment at one dB in the SISI-test procedure. 2) Under the test condition of sensation level of 10dB and intensity increment of one dB, the SISI scores of those with cochlear lesions were remarkably high, the majority showing 80 to 100 per cent. In these, sudden deafness and S.M. deafness showed 90 to 100 per cent of all cases, Ménière's disease and mixed deafness were 80 to 100 per cent scores in 92 to 96 per cent cases. 3) The SISI scores of those with VIIIth nerve tumors were very low, being 0 to 5 per cent. 4) As the criteria of the SISI score, the percentages above 80 were considered as “positive scores”. 5) Those who were proved positive by the Békésy test for the recruitment phenomenon showed scores of 80 to 100 per cent in the SISI-test and the both results were in good agreement.