Tympanoplasties were done on 956 ears (789 persons) in Okayama University for the past 10 years. The results of a long term follow-up were obtained recently in 351 ears (284 persons) of them. In 351 ears, the primary operations were done in 67%, and W-I type∗ and W-II type (these two types are called as “conservative type group”, and the other types are called as “radical type group”) were done in 50%. (∗W-I type means the Wullstein's classification type I.) RESULT 1) The rate of no perforation in tympanic membrane after surgery; The rates in the primary operation and in the revised operation, and in each type of operations were between 84% and 72%. The rates in double grafting, temporal fascia graft, meatal skin flap were between 92% and 67%, but it was less than 73% in thigh skin graft. 2) The results of hearing gain; The average hearing loss of air-conduction in speech range was used for the judgement of hearing gain after surgery. It was regarded as success that (1) the average hearing loss was better than 30 dB, or (2) the hearing gain after surgery was more than 11dB. (A) The rate of success in the conservative type group was 62% in the primary operation, and was 73% in the revision. The rate of success in the radical type group was about 30% in the primary operation and also in the revision. (B) The rates of success in the conservative type group of the primary operation were from 67% to 61% in the double grafting, temporal fascia graft and meatal skin flap, but it was 46% in thigh skin graft. The rate of success of the revision was 90% in double grafting, 86% in temporal fascia graft, 67% in thigh skin graft and 57% in meatal skin flap. The rate of success in the radical type group of the primary operation was 36% in meatal skin flap, 30% in temporal fascia graft, 23% in double grafting and 8 % in thigh skin graft. The rate of success of the revision was 67% in double grafting, 58% in temporal fascia graft, 26% in meatal skin flap and 13% in thigh skin graft. (C) The rate of success was 37% in the modified W-III type and 23% in modified W-IV type. The rates of success of the modified types in which columella with tragal cartilage and transposition of ossicles was used, were from 42% to 27%, but it was less than 11% in polyethylene tube. 3) There was almost no difference in recurrence rate of middle ear inflammation between the open method and the closed method. On the basis of these results, the operation technique was described that was considered to be the most preferable at present in our clinic.
The diagnosis of pollinosis is in general made on the basis of detailed clinical histories, nasal smear, skin tests, the dilution threshold of the skin, provocation tests, P-K tests, the quantity of serum total IgE concentrations and so on. Since the circulating allergen specfic IgE antibody could be measured by the radioallergosorbent test (RAST), the elevation of allergen specific IgE antibody in serum has been considered to be one of the important diagnostic evidences in the reagin (IgE)mediated allergic diseases. The cedar specific IgE antibody was measured by RAST from 86 cases of Japanese cedar pollinosis (with positive histories, positive nasal smear, positive skin test and positive provocation test) and 8 cases of suspicious Japanese cedar pollinosis (with positive histories, positive nasal smear, positive skin test and negative provocation test). The significance of RAST on diagnosis of Japanese cedar pollinosis was evaluated by comparing RAST results with in vivo results (skin tests, the dilution threshold of the skin and provocation tests), total IgE levels and blood eosinophil counts. Results are as follows: 1. The results of skin tests agreed with the RAST results in 76.5%. The correlation between provocation tests and RAST was 80.2%. These experimental results mean that the circulating cedar specific IgE antibody is increased in 70 to 80% of patients with cedar pollinosis diagnosed in vivo diagnostic criteria. The rise of serum cedar specific IgE antibody is regarded as an important evidence of diagnosis of Japanese cedar pollinosis. 2. There is a close relationship between the dilution threshold of the skin and the cedar specific IgE antibody levels (r=0.845). 3. The total IgE concentrations of serum did not correlate to the serum cedar specific IgE antibody levels. 4. The blood eosinophil counts had no relation to either total IgE levels or the cedar specific IgE antibody concentrations.
Many etiologies of sudden deafness have been reported and three of them are especially noticed, which are viral, vascular and labyrinthine window rupture. In addition, immunological factor may also be important. Three cases of sudden deafness with vertige were reported and the etiology discussed in each case. Case 1: A 37-year-old male who had been suffering from common cold for two weeks, complained of right severe hearing loss and Vertigo following sneezing. He was examined and found with high pressure of cerebrospinal fluid (270mm H2O). As there was no improvement in hearing by any treatment, probe tympanotomy was performed and fluid leak at the round window niche was observed (round window rupture). Cerebrospinal fluid was examined virologically and herpes type virus was detected. Case 2: A 71-year-old female complained vertigo and left severe hearing loss after symptoms of common cold. Examination revealed disturbance of the left inner ear function, normal pressure of cerebrospinal fluid (120mm H2O), and round window rupture. Herpes type virus was detected in her cerebrospinal fluid. There was no improvement in hearing by any treatment. Case 3: A 17-year-old high school girl suffered from the sudden onset of severe hearing loss in the right ear vertigo. No episodes like common cold or sneezing were found. Examination revealed only disturbance of the right inner ear function, and her hearing and vertigo were improved by treatment with anticoagulant (heparin). We could not detect virus in her cerebrospinal fluid. On the basis of these findings, it was suggest that Case 1 and Case 2 are of the viral etiology with round window ruptures due to increased pressure of cerebrospinal fluid or of the middle ear cavity associatdd with anatomical factor as patent cochlear aqueduct, and the prognosis of these cases may be poor. Case 3 is suggested to be of the vascular etiology because of good response to anticoagulant, but, as the symptoms of this case resemble those of Meniere's disease, immunological factor may play an important role
Auditory nerve action potentials (AP N1) and summating potentials (SP) which were evoked by sound stimuli were investigated at the first attendance on twenty patients of sudden deafness. A recording was performed by use of the transtympanic needle electrode technique, that is, needle electrode was placed on the promontry through the tympanic membrane and average responses were recorded by a computer. Sound stimulus used was the sine wave of one cycle (duration 0.25msec). This type of stimulus was similar to the click in analysis using sound spectrogram. The patterns of the wave forms of AP and SP response obtained in these cases were divided into the following types. 1. The Dominant -SP: The -SP appears as negative deflection which develops immediately after the start of sound stimuli. The dominant SP having an amplitude almost equal to that of the AP or, having a much higher voltage than that of the normal hearing subject in the segment of High-Response Curve termed by Yoshie (1967) 2. The AP High Response: The wave forms of AP response having a higher amplitude or one almost equal to that of the normal hearing subject in the segment of High-Response Curve. 3. The Decreased AP High Response: The wave forms of AP response having a reduced AP amplitude in the High-Response Curve Segment and loss of the Low-Response Curve Segment.No increment of the N1 amplitude is encountered with increasing intensity. 4. The AP Low Response: The wave forms of AP N1 having a markedly low voltage and delayed latency (>2.5msec) at sound intensity of 90-100dB HL. 5. The +SP: The wave forms of response having a positive deflection that develops immediately after the start of sound stimulus at the intensity of 100dB HL. Neither is the response of AP obtained. 6. The AP and SP No Response: The wave forms of AP and SP responses can not be obtained even at the maximum sound intensity of 100dB HL. A total of twenty patients with sudden deafness was examined by electrocochleography. Therewas a significant difference of the wave forms recorded between the cases of complete recovery or remarkable improvement and cases of slight improvement or no change. In four of the seven cases in which complete recovery or remarkable improvement were shown the Dominant -SP was obtained and in the remaining three the AP High Response was obtained. In cases in which slight improvement or no change was shown Decreased AP High Respnse, AP Low Response, +SP and AP, SP No Response were obtained. It was concluded that the electrocochleography could be very helpful in estimating the prognosis of sudden deafness during the early stage of the onset
Contrast roentgenography of the ethmoid sinuses was carried out by the Proetz displacement method using 20% moljodol on 24 sinuses in 15 controls and on 57 sinuses in 36 cases of chronic sinusitis. The roentgenological findings were compared with their clinical and histopathological findings. The diagnostic significance of contrast roentgenology in ethmoid sinusitis and its related problems were discussed. 1. In the control group, the anterior ethmoid sinuses were well visualized in 79.2% and the posterior ethmoid sinuses in 95.8%. The maxillary, frontal and sphenoid sinuses were replaced by contrast media in less frequency compared with the ethmoid sinuses. In the chronic sinusitis group, the anterior ethmoid sinuses were well visualized in 24.6% and the posterior ethmoid sinuses in 43.8%. 2. Contrast roentgenograms obtained in the upright position revealed a half moon shaped shadow below the horizontal line of contrast media in the control group. The shadows were often irregular in shape in chronic sinusitis. 3. Both control and chronic sinusitis group showed remarkable excretion of contrast media in 24 hours. In some cases of chronic sinusitis group, however, the contrast media still remained for 48 hours. 4. Ethmoid sinuses was easily visualized in those cases with the sinuses which were well developed and were not filled with the secretion and in which pathological changes of the middle meatus were mild. In turn, in the cases with deviation of the nasal septum at its upper portion the posterior ethmoid sinuses were not always successfully visualized. 5. The contrast roentgenological findings and the degree of pathology of the lining membrane were in accordance in 64.9% of the anterior ethmoid sinuses and 78.9% of the posterior ethmoid sinuses. In conclusion, all findings in contrast roentgenogram of posterior ethmoids including the possibility of visualization related with the pathology of the sinuses. Thus, contrast roentgenography was proved superior to other diagnostic methods. In the anterior ethmoids, however, contrast roentgenography is limited to the supplementary diagnostic method because unsatisfactory visualization cannot always be interpreted as an abnormal finding.
Histopathological investigations on the epithelium of the entire larynx were performed to study the origins of laryngeal carcinoma. The research objects were 45 larynges removed from patients with glottic cancer and 56 larynges from patients with supraglottic cancer. The controls were 59 normal larynges from autopsy cases. The squamous metaplasia of the laryngeal epithelia was investigated using the gross staining methods (pyronin Y and alcian blue/phlpxine stainings) of Stell et al. The squamous metaplasia of the supraglottic region was divided into five types: I, the infantile metaplasia type; II, the marginal metaplasia type; III, the island-like metaplasia type; IV, the wide field type; and V, the total metaplasia type. The metaplasia of the subglottic region was divided into two types; the continuous metaplasia type and the island-like metaplasia type. In the controls, the metaplasia was found to have progressed with aging in the supraglottic region. In the supraglottic cancer group, the metaplasia of the supraglottic region was in high degree in contrast with the controls and glotticcancer group. The metaplaplasia was a little stronger in the glottic cancergroup than in the controls. No relation was found between the progress of the cancer and that of metaplasia. Of the larynges subjected to the grass staining method, serial sections were prepared from 47 and these sections were studied microscopically. Most of theepithelia showed stable metaplasia, but there were various types of dysplasia in part. This finding was often seen in the supraglottic region of larynges from supraglottic cancer cases and in the non-cancerous vocal cords in larynges from glottic carcinoma cases. From these results, it can be assumed that the metaplasia in the supraglottic region plays a major role in outbreaks of supraglottic carcinoma.
We have experienced 23 cases of multiple primary malignant tumors in the Department of Oto-rhino-laryngology, Keio University from 1957 to 1975. On the other hand, 203 cases of multiple primary neoplasms in the head and neck were reported in the Japanese literature. Of 1093 malignant head and neck tumors in our clinic in the same period, 23 cases (2.1%) were multiple primary malignant neoplasms. The average age was 61 years in our series and 60 years in cases reviewed from literature. Males proponderated, 140, as against females 51. As to the interval between the first and the second tumor, 9 cases (39%) were synchronous and 14 cases (61%) were non-synchronous in our own series. However, 64 cases (35.2%) were synchronous and 118 cases (64.8%) were non-synchronous in reviewed cases. Of 23 multiple primary malignant tumors in our clinic, malignant antral tumors were most frequently seen (10 cases) and laryngeal cancer were next (6 cases). On the other hand, of 203 cases reviewed from literature, maxillary cancers were also most frequently seen(90 cases)and laryngeal cancers were next (71 cases). Cancers of bilateral maxillary sinus were most frequently seen and double cancers of the larynx and the stomach were next frequent in Japan. The cause of multiple primary cancer was discussed.