Humoral as well as cellular immunological functions were examined before and after tonsillectomy in 84 patients with recurrent tonsillitis. The patients were divided into 3 groups: Group A: under 8, Group B: 9-15, Group C: over 16 years. Elevated IgG was observed in 29.8% of Group A, in whom IgG returned to normal after tonsillectomy. IgG was low in 25% of Group B before tonsillectomy, which remained still low one month after tonsillectomy. Higher incidence of low CH50 was observed in elder patients suggesting that chronic pathological changes exist in tonsils of these age groups. The low CH50 value tended to become normal after tonsillectomy. C3c was reduced before tonsillectomy in 69% of Group A, 60% of Group B and 60% of Group C, respectively. C3c, however, remained unchanged after tonsillectomy. The subpopulation of the T lymphocyte and the rate of lymphocyte blastic transformations estimated by PHA-P or PWM were low before tonsillectomy and became normal after tonsillectomy in many patients of the 3 age groups. While the peripheral T lymphocytes decreased in number in elder patients, the number of the T lymphocytes in removed tonsils increased as the age of the patients advanced. This study would suggest that decision has to be made carefully whether tonsillectomy is indicated in Group A and B depending upon the results of immunological investigations. It is also suggested that immunological laboratory tests such as immunoglobulins or CH50 should be serially carried out after tonsillectomy.
In order to study the manifestations and genesis of cholesterol deposits in the paranasal sinus, 379 specimens from 100 operated paranasal sinuses were histologically examined. Two hundred and twelve specimens from 50 paranasal sinuses were obtained from 31 patients who received operations for sinusitis from one to 4 times in past and 167 from 50 were obtained from 27 patients who had no operation. They showed various degrees of inflammation. The specimens were picked up from the maxillary sinus, ethmoid sinus, sphenoid sinus, frontal sinus and supraorbital cell at operation. Although cholesterol deposites were not found in 167 specimens from 27 patients without operation, the lesions were found in 3 from 3 patients with operations. Two were in the maxillary sinus and one in the supraorbital cell. These three sinuses were obstructed at their orifices. These specimens showed very mild inflammation. Since cholesterol deposits in the paranasal sinus appear in the mucous membrane with very mild inflammation of the obstructed sinus, the situation of the deposits seems to be identical with that of the temporal bone. Therefore it can be considered that the genesis of cholesterol deposits in the paranasal sinus and temporal bone might be identical. As the deposits were found only in the operated sinuses, surgery gave access to the situation, i. e., obstructed sinus and weakened inflammation. As the occurrence and the amount of the deposits in the paranasal sinus are much less than those in the temporal bone, the treatment for sinusitis with cholesterol deposits becomes rarely difficult.
Nasal mucociliary clearance was measured in healthy human subjects, laryngectomized patients and patients with chronic sinusitis, Sjogren's syndrome or Kartagener's syndrome. A Tc99m tagged resin particle technique for the measurernent of mucociliary transport rate(MTR) and a saccharin granule technique for the measurement of mucociliary transit time(ST) were used in this study. MTR averaged 6.4mm/min±3.4 in normal control subjects and 7.0mm/min±4.1 in laryngectomized patients. MTR in the patients with chronic sinusitis or Sjogren's syndrome averaged 3.5mm/min±2.6 and 1.8mm/min±2.8, respectively. They were significantly lower than control. The observed depression of particle transport in the patients with chronic sinusitis or Sjogren's syndrome could be due to quantitative and qualitative changes in nasal secretion. The particle movement was not observed in a patient with Kartagener's syndrome. ST averaged 14.3min±6.6 in 20 normal subjects, 3 patients with chronic sinusitis and a patient with nasal allergy. ST in 7 normal subjects averaged 14.8min±3.1 in a long term observation. Interindividual variation for ST was smaller than that for MTR. Although significant inverse correlation between MTR and ST was found, there were some occations of slow clearance in MTR with fast ST clearance, and vise versa. Saccharin technique was found to be simple and useful for a measurement of mucociliary transit time. The difference between these two methods might be explained by the notion that the MTR measured the mucus clearance and the ST might reflect clearance performed by both periciliary fluid and mucus.
The time required for mucociliary clearance from the nasal turbinate and the maxillary sinus was investigated in the same individual chickens using a specially designed plastic holder to monitor mucociliary clearance rates by direct vision through the palatine cleft. Determined in this way were: 1) the effect of SO2 exposure during 16 hours per day for 7 consecutive days, 2) the effect of intranasal inoculation with the mesogenic strain of Newcastle disease virus (NDV), 3) the effect of mechanical stimulation of the palatine cleft by gentle touching with a dissecting needle, and 4) the effect of the nerve blocking drugs; atropine, scopolamine, reserpine and propranolol on the mechanical stimulation. Intermittent exposure to 6ppm of SO2 produced a turbinate time curve with double peaks of deceleration and intervening recovery periods, suggesting an intranasal mucociliary homeostatic response. In individual animals, 26 of 35 animals (75%) exposed to 6ppm, and 5 of 10 animals (50%) exposed to 20ppm showed the same patterns. Sinus clearance time in the chickens exposed to 20ppm of SO2 returned to nearly normal after deceleration, suggesting also homeostatic mechanism. NDV infection in chickens from a vaccinated flock induced little deceleration of intranasal clearance, while significant slowing was induced in chickens from an unvaccinated flock. This suggest that the severity of an intranasal infection may be measured by the rate of mucociliary clearance. Sinus clearance time in the NDV-infected chickens from an unvaccinated flock was accelerated between 2 to 5 days after infection in comparison with control levels, suggesting another type of mucociliary homeostasis due to NDV infection. In the chickens from a vaccinated flock, sinus clearance time was not affected by NDV infection. Mechanical stimulation caused acceleration of mucociliary flow of the sinus: sinus clearance time was accelerated on the side adjacent to the mechanically stimulated side of the palatine cleft. Mucociliary clearance in the chicken sinus was not affected by parasympatholytic agents, but was decelerated by the beta-adrenergic blocker. The effect of nerve blockers on the mechanical stimulation showed that parasympatholytic agents blocked the response induced by mechanical stimulation, while sympatholytic agents did not completely block the response. These data suggest that mucociliary clearance may be regulated by the reflex of the para- sympathetic and partially sympathetic nerve fibers.
Waardenburg thought that Waardenburg's syndrome is inherited in an autosomal dominant manner. We picked up the four families with Waardenburg's syndrome at three deaf schools in Shizuoka prefecture and investigated their pedigrees, using two major characteristics of blue eyes and deafness. We found that two families are inherited as an autosomal dominant, one, as an autosomal recessive and one, as a fresh mutant.
Four cases of acute otitis media due to Mycoplasma pneumoniae were studied. Characteristics of the cases were as follows: Three cases had pneumonia simultaneously, but the remaining one had no pneumonia or bronchitis. Examination of the tympanic membrane revealed mild to strong inflammation, or bleeding. Blebs and spontaneous perforation of the tympanic membrane were not found. The nature of middle ear effusions was serous and not purulent. In three cases the nasopharynx was markedly swollen. In two cases especially, the nasopharynx showed tumor-like appearance with thick exudate. The diagnosis of Mycoplasma infection was confirmed serologically, but Mycoplasma culture of middle ear effusions and nasopharyngeal secretion was unsuccesful.
Computed Tomography (CT) was supplementary and effectively employed for diagnosis of parotid gland tumors in 33 patients. The usefulness of this technique for determing of location of tumor and for differential diagnosis was investigated. The results were as follows: 1. The depth of tumor expansion into the parapharyngeal space was clearly evaluated by CT, 2. It may be assumed that a tumor locates in the superficial lobe, if it appears outside a line drawn between the mastoid process and the mandibule. 3. If the margin of tumor appears irregular, and its content is heterogenous, diagnosis of a high-grade maligancy will be made. CT is of limited usefulness in diagnosing low-grade malignancy. 4. Clear and lowdensity of a tumor shown in CT can be suggestive of a cyst.
Validity of the middle ear muscle reflex in diagnosis of facial palsy was examined in 36 patients with acute peripheral facial palsy. Averaged middle ear muscle reflex and the ear canal pressure were measured consecutively in the course of the palsy together with other tests (EM, evoked EMG and NET) and score of the palsy. It was revealed that the reflex value correlated closely with both the score of palsy and the value of evoked EMG. Thus, measurement of the middle ear muscle reflex was found to be simple but reliable enough for evaluation of the degree and prognosis of facial palsy. Although the method has inherent difficulties in descriminating the participation of the tesor tympani muscle activity and in disclosing weak or false negative activity, simultaneous recordings of impedance and canal pressure seemed to be promising for the solution of these problems.