Questionnaires relating to nasal symptoms were answered by 70 patients with nasal obstruction and 20 normal subjects. The questionnaires consisted of 20 items including various symptoms supposedly caused by nasal obstruction. Examinations such as rhinoscopy, radiography and the measurement of the nasal resistance were also carried out. We realized that patients often regarded the sense of nasal obstruction as the equivalents of such symptoms as necessity of mouth breathing, snoring, the sense of distress, hyposmia, and nasal voice. In the majority the sense of nasal obstruction was well correlated to the value of the nasal resistance. However, patients with high nasal resistance sometimes did not complain of nasal obstruction and ones with low resistance complained of nasal obstruction. The comparison of questionnaires and the results of the examinations drawn from the patients with such paradoxical obstruction suggested the following possibilities. 1) A patient's insistence that a symptom was caused by nasal obstruction. 2) Day-to-day variation of the nasal patency. 3) Errors attributed to instruments, examiners and/or examinees. 4) Sense of changes in the work of breathing.
Relation between duration of hoarseness and tumor size or stage was studied on 249 cases of glottic carcinoma who were treated in National Cancer Center Hospital. From this study, growth of carcinoma of vocal cord can be divided into three types. 1. The cases in which carcinoma is limited to Tla for long time and then extends to deeper tissue without any apparent extension on the surface of mucous membrane and then the vocal cord is fixed (T3). In these type of T3 cases, carcinoma is limited to the involved side of the larynx for long time. Average duration of hoarseness in these cases is approximately 11 months. 2. The cases in which carcinoma extends to the opposite cord or the supraglottic or the subglottic region. In this type of extension, tumor usually extends superficially and average duration of hoarseness is about 6 months. 3. This type of carcinoma can be found in T3 cases in which carcinoma extends beyond midline of the larynx. Carcinoma extends to both superficial and deep tissue. Mean duration of hoarseness in these cases is 4 months. For early diagnosis of the vocal cord carcinoma, it is important to give the information about the disease to the people. Analysis of our cases revealed that 70% of the cases with carcinoma of vocal cord were Tla when the patients visit doctor within three months after the onset of hoarseness. However, early detection of the vocal cord carcinoma depends on the nature of tumor itself, and there are many patients with Tla carcinoma, who don't visit doctor for long time after they noticed hoarseness. On the other hand, the patients are often encountered in whom the advanced carcinoma is detected in spite of earlier consultation.
The relation between prevalence of influenza and the number and age was investigated in patients with idiopathic laryngeal recurrent nerve palsy who visited our ENT clinic during 20 years from 1960 to 1979. The results are as follows: 1) The number of patients with idiopathic laryngeal recurrent nerve palsy increases when the influenza A virus with a new antigen type or the influenza B virus with a remarkable different antigen type appeared. 2) The rate of patients with idiopathic laryngeal recurrent nerve palsy to the general population increases in proportion to the age. This increase is more remarkable in the nonprevailing periods than in the prevailing periods of influenza viruses.
Based upon observations on clinical pictures of 98 patients with Bell's palsy or RamsayHunt's syndrome, the following results were obtained. 1) Bell's palsy was frequently found in children under 3 years of age, while no Ramsay-Hunt'ssyndrome was found. 2) As to sex-difference, males were more frequently suffered from Ramsay-Hunt's syndrome. 3) Periauricular pain, in a broad sense, was noticed in about 90% of cases with RamsayHunt's syndrome, and it seemed to be diagnostic of the disease. 4) The clinical pictures of Ramsay-Hunt's syndrome were various, and atypical types were noticed more frequently than typical ones. 5) Occurrence of each of three major manifestations Ramsay-Hunt's syndrome was about 80%. 6) The diagnosis of geniculate herpes zoster should carefully be made, because the clinical findings varied according to the clinical stages, and the clinical course was not always typical. 7) Of VIIIth nerve involvement, cochlear symptoms (tinnitus and hearing loss) were often found independently. Vestibular symptoms without cochlear signs were seldom found. 8) The primary lesion of Ramsay-Hunt's syndrome was considered to be the geniculate ganglion or the vestibulocochlear ganglion. 9) At least, one third of Bell's palsy were actually considered to be of atypical Ramsay-Hunt's syndrome. 10) Some cases with clinical diagnosis of sudden deafness or cochlear neuronitis could possibly be of atypical Ramsay-Hunt's syndrome. 11) Differential diagnosis of Bell's palsy from Ramsay-Hunt's syndrome should be made by careful taking of the patients' history and the physical examinations. Especially the existence of geniculate herpes zoster and hearing loss should carefully be confirmed.
The function of the parotid glands were studied in 45 patients with parotid gland diseases, with the salivary glands affection systemic diseases, and with radiation injury of the parotid glands. As a control, the studies were done on 13 patients with no history of salivary gland disease. The method is consisted of sequential scientigraphy using a gamma scintillation camera and simultaneous recordings of the time-activity curves for the regions over the parotid glands and Stensen's orifices. The examination was commenced immediately after intravenous injection of 99mTc, and was continued up to 30 minutes. Salivation was stimulated with oral administration of tataric acid at 20 minutes after injection.According to whether the uptake, oncentration and excretion of 99mTc were diminished or increased, the time-activity curves could be grouped in following four different patterns. Pattern-A. Parotid gland activities continuously increased with time, whereas the orifice activities were no more than those of background and the curves maintained a lateau in shape. However, sudden decrease was observed in parotid gland activities immediately after salivary gland stimulation. Such a decrease always orrelated with a concurrent sharp increase over the orifice activities. This pattern was typical of controls. Pattern-B. Both of the time-activity curves maintained a plateau during entire period of examination, although parotid gland activities were consistently higher than those of the orifices. Such reduced uptake with a reduction in salivary excretion was observed in parenchymal damage of parotid gland by parotid cancer, chronic parotitis, Sjögren's syndrome and post-irradiated sialopathies. Pattern-C. Parotid glandular curves showed continuous increase with time, while the orifices ones were similar to those observed in control subjects. Such increased uptake with normal salivary excretion was noted in patients with oral mucositis, who had received chemotherapy and cobalt radiation for the carcinoma in the unilateral maxillary sinus. Pattern-D. In spite of continuous increase of parotid gland activities, the orifice activities changed little in the entire time sequence. This pattern, which was characterized by increased concentration with a reduction in salivary excretion, corresponded with xerostomia resulting from sialosis. Using this method, a clinician can determine the exact stage of glandular dysfunction.
From May to June, 1980, 2, 238 school children from 7 primary schools in Miyagi prefecture were oto-rhinologically examined to estimate an accurate incidence of chronic rhino-sinusitis in school children. Five of the 7 schools are located in the rural area and the remaining 2 schools are located in the urban area. The following results were obtained; 1) Nasal secretion was diagnosed to be abnormal in 56.5% of the children, including serous in 17.6%, mucous in 25.5% and purulent in 13.4%. 2) The nasal smear test showed massive infiltration of neutrophils in 22.9%, eosinophils in 5.8% and both cells in 3.8%. 3) X-ray examination of the paranasal sinuses was performed in 347 children from 4 primary schools (Two in the rural and the other two in the urban areas). Abnormal findings indicating paranasal sinusitis were detected in 179 cases. Thus chronic sinusitis is found in 10.5% of the children in the 4 schools. 4) Statistical analyses showed that there was the significant difference of incidences of the chronic snusitis in the children between the rural (15.1%) and urban (7.9%) areas (p<0.01). 5) The X-ray examination showed the first grade children were affected by the chronic sinusitis most frequently. The incidence gradually decreased as the grade progressed. 6) The massive infiltration of neutrophils in the nasal smear was most frequently observed in the first grade and its incidence also decreased as the grade progressed. The infiltration of eosinophils, on the contrary, persisted throughout the all grades of the primary school children. 7) The maturation of imniunological mechanisms of the upper respiratory tract seems to play a role in this spontaneous subsidance of the recurrent rhino-sinusitis in the primary school children, although no marked declining of the incidence was seen in the cases of the immediate-type allergic reaction.
The development of the rabbit submandibular gland was investigated by electron microscopy. Adult, 1st-5th day's postnatal, and 18th-29th day's prenatal rabbit submandibular glands were used. The results obtained are as follows; 1) Approximately on the 20th embryonic day, the rabbit submandibular gland tissues were occupied by coarse bush-like structures, consisted of primary ducts and terminal bulbs. A few days later, the lumen formation was observed in the terminal bulb. By the 24th day, the terminal tubular cells and proacinar cells were apparently distinguishable from undifferentiated cells in the terminal tubules. On the 26th day, the differentiation of the terminal tubular cells into the granular segmental cells, and the proacinar cells into the acinar cells were evident. 2) On the 23rd day, the primary intercalated ducts, originated from undifferentiated cells in the terminal bulbs, were seen between the terminal tubule and the primary duct. Intercalated ducts were clearly found on the 26th day. Some of the intercalated ductal cells contained the same granules as found in the terminal tubular cells. This fact indicated that some of the terminal tubular cells were differentiated into the intercalated ductal cells in the late embryonic days. 3) Approximately on the 28th or 29th day, the primary striated ducts were originated from the primary ducts in close proximity to the intercalated ducts. However, the striated ducts were unremarkable even on the 5th postnatal day. It was considered that the primary ducts at the distal portion of the primary striated ducts were differentiated into the excretory ducts. 4) Myoepithelial precursor cells, originated from the undifferentiated cells of the terminal bulb, were found at the basal portion of the terminal tubules on the 23rd day. On the 24th day, myofilaments were obviously observed in the cytoplasm of some of the precursor cells. Therefore, myoepithelial cells were considered to be epithelial origin.