Many research works have been published on the efficiency of the nose for conditioning of respiratory air. Since the temperature and humidity of the respiratory air show cyclic fluctuation with respiratory movement, accuracy of measurement is influenced markedly by the response time of the measuring instruments. With recent development of the medical electronics, these measurements have become easier and more accurate. To evaluate influence of morphological features of the nasal cavity and modes of respiration on the air conditioning capacity of the nose, experiments were performed in normal subjects, patients with atrophic rhinitis and in tracheotomized subjects. The temperature and humidity of, the respiratory air were measured by fine thermocouples and a respiratory Mass Spectrometer (Varian Matt M3-BA). The temperature and humidity of experimental environment were 21-24°C and 14.08mmHg. The present experiments revealed the following: 1. In normal sbujects inspiratory air temperature increase in the mesopharynx was as follows. Each value represents temperature increase divided by temperature difference between the environmental air and body temperature. nasal resting breathing: 75.5%, nasal deep breathing: 67.3% oral resting breathing: 58.4%, oral deep breathing: 46.7% In the cervical trachea temperature increase was as follows. nasal resting breathing: 80.7%, nasal deep breathing: 70.8% oral resting breathing: 71.8%, oral deep breathing: 58.6% 2. In subjects with atrophic rhinitis the inspiratory air temperature increase in the mesopharynx was as follows. nasal resting breathing: 65.0%, nasal deep breathing: 53.2% oral resting breathing: 57.0%, oral deep breathing: 42.3% In the cervical trachea, temperature increase was as follows. nasal resting breathing: 76.6%, nasal deep breathing: 67.8% oral resting breathing: 70.4%, oral deep breathing: 53% 3. The expiratory air temperature in the nasal vestibulum was 3.7-C below the body temperature in the normal and 1.9°C below in the nose with atrophic rhinitis which corresponded 23.8% and 13.4% of the difference between the body and environmental air temperature. 4. In normal subjects the humidity of the expiratory air showed marked difference between nasal breathing (34.8-38.7mmHg) and oral breathing (43.6-44.3mmHg). But in subjects with atrophic rhinitis, the difference was minimal. The inspiratory air humidity in the cervical trachea in the normal was 43.3-46.8mmHg and difference between nasal and oral breathing was minimal ranging 1.6-2.2mmHg. 5. Relative humidity is directly influenced by temperature change. Depending on the difference in respiratory modes and morphological features of the nasal cavity, the extent of the respiratory mucosa participating in conditioning of inspiratory air differs and the lower portion of the respiratory tract becomes involved in certain conditions.
Authors investigated normal development of the footplate of human stapes with the histological serial sections under the microscope, properly with the phase contrast apparatus. Materials were 35 human embryos, in the embryonal age from 6 weeks to 32 weeks. Eighteen embryos of early stage (C.R. Length 3.5mm.-105mm.) were particularly observed on lamina stapedialis of otic capsule. The above mentioned area was suggested by Cauldwell and Anson to take part in composing the vestibular surface of the footplate, stapedial rim and annular ligament. According to our study, the primordial formation of lamina stapedialis appears histologically in the 16mm. embryo, and the lamina is completely formed and fused to the base of annular stapes in the 35mm. embryo. In the 50mm. embryo, the adult form of the stapes was built with it's rim and annular ligament. With the results of our observations, authors are agreed with the opinion persisted by Cauldwell and Anson, the vestibular surface of the footplate, the stapedial rim and annular ligament were derived from lamina stapedialis, and presumed that the various types of the malformation, clinically found in this area, e.g. congenital footplate fixation, congenital absence of oval window, calcification of annular ligament and bony fusion of footplate to otic capsule etc, could arise clinically.
For diagnosis and treatment of dysosmia, a useful technique has been developed in our clinic, that is, a macroscopic observation of the olfactory mucous membrane utilizing an endoscope. For this study, an Olympus Selfoscope SES-1711D was used as an endoscope with a diameter of 1.7mm, and it was inserted into the rima olfactoria under non-anesthetic condition. Thirty-one normal cases and 64 cases of dysosmia were employed, as the subjects. The normal olfactory mucous membrane was well lubricated as that of the respiratory region, but a slight niche was found on its surface. The olfactory mucous membrane was light brownish-yellow. The boundary area of he olfactory mucous membrane was gradually transmuted into the respiratory region. The olfactory mucous membrane of dysosmia was divided into the following 4 types in this observation. (i) Swelling type: The olfactory mucous membrane was coated with increased secretion, looked rather pale, and most of the niches were decreased or disappeared, 22 cases. belonged to this type. (ii) Secretory type: Even niches and the color of the olfactory mucous membrane were similar to normal cases, but the secretion was increased. This is observed in 10 cases. (iii) No change type: No abnormalities were found on the olfactory mucous membrane in 17 cases. (iv) Dry type: Secretion of the olfactory mucous membrane appeared to be reduced or dried, and the color was rather brownish. This is shown in 9 cases. The dry type was further divided into 2 types. (a) Atrohic type: The niche of the olfactory mucous membrane became deeper; 6 cases. (b) Hypertrophic type: The niche of the olfactory mucous membrane disappeared or became shallow; 3 cases. Further, in 6 cases, different observations were obtained in both sides of the nose. In these, there were no pathology in one side, and in another side, 5 cases were the swelling type and 1 case was the secretory type. In most cases cf the swelling type and secretory type, the olfactory mucous membrane returned normal, but the cases in the no change type and the dry typf got no remarkable improvement by the treatment. By this method, the olfactory mucous membrane of dysosmic patients was able to be observed directly and the effect of the treatment was easily traced, therefore, more exact diagnosis, treatment, and accurate prognosis could be performed.
Tracheoesophageal shunt technique which was first described by Calcaterra (1971) and Komorn (1973) was first used in Japan for vocal rehabilitation in 6 laryngectomized patients since 1975. Four of them acquired useful speech without serious aspiration or dysphagia. Tracheoesophgeal speech is superior to esophageal speech in duration of phonation and in formation of pitch. A flap of 2 cm in width and 4 cm in length to make the shunt is suitable for the Japanese, and a tracheal meatus for the shunt is to be placed 1cm below the distal end of the trachea with a horizontal incision from I to 1.2 cm in the middle of the posterior wall of the trachea.
In the past 14 years, 32 patients (22 males and t0 females) of the laryngeal papilloma were treated at the Department of Otolaryngology, Gunma University Hospital. Most of them were in a range of 30-60 years of age. Ten out of 32 patients were in sixties. Only one patient was under 10 years of age. On laryngoscopic examinations the lesions showed hyperkeratotic appearances. The child showed atypical findings from those of the so-called multiple juvenile papilloma. Patients with the localized type papilloma were completely cured by surgery. However, the diffuse type papilloma was resistant to either radiotherapy or chemotherapy. From long-term follow up studies, was observed in 5 patients (all males) malignant transformation. An interval between the onset of the symptom (hoarseness) and malignant transformation was from 4 to 9 years. Laryngectomy was performed for all patients. Three cases out of then were examined by serial large sections and it was shown that the tumor extended to the underlying tissue and that in one case it invaded the laryngeal cartilage. All of them servived without evidence of recurrence or metastasis.
Recently the fine structures of outer hair cells in guinea pigs, rats, rhesus, monkies, cats, mice and humen have been made clear by electron microscopy. But we have very little information on these in rabbits at the ultrastructural level. I examined electron microscopical and histochemical features of normal outer hair cells, in rabbits and changes of those cells after acoustic exposure. The outer hair cells in rabbits were essentially similar to those of other animals. However, the distribution of organelles in the infranuclear region of these cells differed from that of others. In this region of rabbits, many small vesicles, coated vesicles, and multivesicular body were present, but there were few or no mitochondria. The hyaloplasm of this region had higher electron density than did the supranuclear region. This infranuclear region showed a marked lactatic dehydrogenase enzymatic activity but there was no succinic dehydrogenase activity. The outer hair cells of exposed rabbits showed distortions or swellings, and the sensory hairs showed blebs. Numerous lysosomes were seen in the subcuticular region of the outer hair cell, and below this region the organelles had a tendency to be sparsely distributed and the cytoplasmic matrix between them had a tendency to appear lighter than normal. In the infranuclear region, small vesicles, free ribosomes and coated vesicles decreased in number and the cytoplasmic matrix between them became lower in electron density. In this region, the lactic dehydrogenase activity decreased. These electron microscopical and histochemical changes were seen mainly in the lower half of the second turn. In the basal turn, the outer hair cells were almost normal, however occasionally it was found that in the infranuclear region, electron microscopically small vesicles were very densely packed and the cytoplasmic matrix between them appeared darker than normal, and histochemically the lactate dehydrogenase activity increased more than normal. Small vesicles were found to be preferentially distributed in the presynaptic side of the afferent nerve endings after acoustic exposure. Movement of these small vesicles led to speculations that these small vesicles have a close relationship to the afferent nerve endings.