The purpose of this study is to clarify the role of peptide leukotrienes(LTs) on the onset of characteristic hyperreactive nasal symptoms of nasal allergy by observing the time course of the correlation among degrees of nasal symtoms, and by observing the amount of chemical mediators and the number of inflammatory cells in the nasal lavage fluid after nasal antigen challenge in subjects with Japanese cedar pollinosis during off season. Sneezing was terminated within 10 minutes and nasal discharge within 2 hours. However, time course change of the percent increase of nasal airway resistance showed dual response consisting of immediate and late phase responses. The peak of the former was seen at 30 minutes and the latter was at 7 hours after provocation. The significant increase of eosinophils in the nasal lavage fluid was observed during both the immediate and the late phase responses, but during the late phase response, the increase was more prominent. Basophilic cells definitely increased during the late phase response. The amount of LTs in the nasal lavage fluid increased significantly during both the immediate and the late phase responses. In contrast, the level of histamine increased significantly only during the immediate phase response.Considering that LTs, especially LTD, , has potent and persistent effect on causing swelling of nasal mucosa, LTs may play important role in causing nasal obstruction during both the immediate and the late phase responses after antigen challenge. On the other hand, the role of histamine may be confined to cause the hyperreactive nasal symptoms during the immediate phase response. Our results also indicate that the source of LTs in the nasal lavage fluid during the immediate phase response is mast cells in nasal mucosa, and during the late phase response, eosinophils and basophils are important as the source of LTs in addition to mast cells.
As a routine preoperative evaluation for chronic sinusitis and postoperative maxillary cyst (mucocele and pyocele), CT scans and B-mode ultrasonic diagnosis including three methods, linear, sector, and convex scans, were performed. By chronic sinusitis, 112 sides by linear scans, 43 sides by sector scans, and 29 sides by convex scans were included in the study. By the postoperative cyst, 43 sides by linear scans, 24 sides by sector scans, and 12 sides by convex scans were included. The positive diagnostic finding by ultrasonography is defined as the depicted echo of the posterior wall. In chronic sinusitis, positive diagnostic rates were as follows : linear scans, 73.2%, sector scans, 88.2%, and convex scans, 77.8%. As for the scan planes, horizontal plane yielded more positive than sagittal one. In postoperative cyst similarly, linear, 86. 0%, sector, 95. 8%, and convex, 83. 3%. Horizontal more positive than sagittal also. The negative findings were caused, in chronic sinusitis, by attenuation by the air in the sinus, thick anterior wall, and artifacts. In postoperative cysts, the negative findings were caused by specific location of the cysts (lateral or posterior). Our results recommend the use of sector scan because of its easy manipulation and higher positive diagnostic rates due to the radial beam conforming to the curvature of the posterior wall. Especially, the sector scan was higher diagnostic rate than linear scan, because the sector scan transmitted radial beam, and received its reflective wave easily from a curved posterior wall of the maxillar sinus. The sector scan, its maniputation is easy, and its diagnostic rate is higher than any other scans.
To investigate the influence of middle ear effusion (MEE) on perilymph (PL) and the round window membrane (RWM), an experimental otitis media with effusion (OME) was manufactured in chinchillas by injecting the tympanic cavity with immune complexes. The presence of MEE lasted 9 days after the injection of immune complexes. Perilymph was aspirated on the fourth, tenth, 21st, and 60th days after the inoculation. The mean concentrations of albumin, IgG, histamine, and prostagrandin E2 (PGE2) were significantly greater in PL obtained from OME-induced ears than in those from normal control ears. The 3H-PGE2 placed on the RWM of pathologically affected ears passed into PL in significantly greater amounts, compared to normal control ears. The findings of the present study indicate that MEE affect the biochemical milieu of PL.
Vibration mode of the ossicles was investigated in twelve fresh human temporal bones using a video measuring system (VMS, Technical Insrtument). This system allows one to observe the ossicular vibration and to measure its vibration amplitude (up to 0. 2 micron) and phase angle. In this study the inner and middle ear was kept intact except for two small holes in the tympanic tegmen. These holes were for the observation of ossicular movement and were covered with a thin cover glass during the experiment. The vibration amplitude and phase angle of the umbo, malleus head, lenticular process and stapes head were measured at 19 frequencies between 0. 1 kHz and 4. 5 kHz. The umbo moved piston-like at 0. 1-0. 8 kHz and 2.6-4.5 kHz but in an ellipse at 1. 0-2.4 kHz. The malleus head showed elliptical movement with its long axis anteriorly tilted around 45 degrees from the direction of the umbo vibration at 0. 1 kHz. Both the lenticular process and stapes head showed similar movement ; piston-like in lower frequencies and elliptical in higher frequencies. The umbo, lenticular process and stapes head vibrated parallel at lower frequencies. The position, displacement and phase angle of the rotation axis of the ossicles was calculated based on the displacement and phase angle of the umbo, malleus head and lenticular process. The axis was around the level of the neck of the malleus in frequencies lower than the resonant frequency, beneath the level of the short process near the resonant frequency and at the top of the malleus head in higher frequencies. The average axis displacement was 0. 9 microns at 1 kHz but much smaller at frequecies lower than 0. 8 kHz or higher than 2 kHz. This suggests that such axis movement may reduce the efficiency of the middle ear sound transmission.
Ninety eight cases with functional deaf who visited in recent 13 years were studied. The results were as follows ; 1) Patients were likely to increase in the last 10 years. 2) Females seemed to be more frequently suffered from functional deafness rather than males. 3) It was found that there were two peaks of age when patient had functional deafness. 4) Chief complaints in most cases were hearing loss. 5) Pure tone audiograms in these cases showed bilateral in most cases. symmetrical curve, sensorineural in type, flat and sloping in shape (including saucer type), and its hearing level revealed in 30-40dB in most cases. 6) Bekesy audiometry was useful for diagnosis. Ninety cases out of 98 showed the V type of Jerger classification. 7) Psychological problems related to troubles of school and friends were observed as causative factors, and episodes concerned otological problems were found to be as triggers. 8) It is possible to make sure a diagnosis by using ABR. For diagnosis, however, it was necessary to doubt the presence of this disease, and then it was important to find out the discrepancy in a battery of hearing test. 9) In some cases, the exactly the same, but higher threshold levels for hearing are always detected in repeated examinations of their audiograms, suggesting the actual disturbance of the loudness recognition in these patients.
Three cases of inner ear barotrauma with subjective symptoms and hearing impairment which were similar to the low tone sudden deafness were reported. Case 1 was a 34-year-old man who developed a hearing loss in the next morning of taking an airplane and recovered four days after. Case 2 was a 42-year-old man who developed a hearing loss 2 days after flying in an airplane and hearing loss have recurred 4 times in his right ear for 3 months. Eight months after recovery of previous recurrent attack, a hearing loss ocurred in his left ear without flying and recurred twice for 3 weeks. Case 3 was a 25-year-old woman who developed a hearing loss in the right ear after 24 meter depth scuba diving and recurred 4 times for 40 days. Those three patients complained of no vertigo at any attacks and were treated conservatively. . From previous reports and the onset and the course of hearing disturbance, acute low tone sensorineural hearing loss in case 1 and case 2 was thought to be caused by circulatory disturbance of the inner ear and in case 3 thought to be caused by inner ear window rupture. But, endolymphatic hydrops was also needed to be take into account in those three cases as a common possible cause. Inner ear barotrauma and so called labyrinthine window rupture were considered to be one of the diseases needed to differentiate from low tone sudden deafness without reference to mono-attack type or recurrent type.
The relationship between the contralateral hearing threshold in the operated ear and the type of tympanoplasty and the hearing threshold in the operated ear was investigated in this report. The subjects of analysis were 863 ears that received tympanoplasty during the past nine years at the Nippon Medical School Main Hospital. Patients who had good hearing in the contralateral ear received type I tympanoplasty more frequently than did those who had poor hearing on the contralateral ear. On the other hand, patients who had poor hearing in the contralateral ear received a modified type III tympanoplasty more frequently. Patients who had good hearing in the contralateral ear tended to have better hearing in the operated ear compared to those who had poor hearing in the contralateral ear. The hearing threshold in patients who had normal contralateral hearing on the average had 20 dB better hearing than did those who had profound hearing loss in the contralateral ear. More than one third of the patients whose hearing thresholds were worse than 30 dB in the operated ear also had a contralateral hearing loss of 30 dB or more. The decision to perform tympanoplasty in cases of the better hearing ear or the only hearing ear must be made very carefully. The contralateral hearing in patients with chronic otitis media, however, is frequently not normal as was evidenced in this investigation. Also, patients who had poor hearing or were deaf in the contralateral ear received more benefit by tympanoplasty than did those who had good hearing in the contralateral ear. Thus, the otologic surgeon should improve his techniques to cope with difficult cases, such as the better hearing ear and the only hearing ear.
A severe case of congenital laryngeal web with subglottic stenosis was reported. The patient had weak crying after birth and stridor was noticed from one month old. He had tracheostomy at two month old and the incision of the web was attempted under laryngomicrosurgery with CO2 LASER, although the attempt failed due to combined subglottic stenosis. The "trough method" was applied at the age of one year. The web was incised and subglottic granulation including the excessive cartilaginous tissue was removed through a laryngotracheal fissure. A piece of silicone membrane was inserted between the vocal cords preventing from adhesion and a silicone tube stent was also inserted into the subglottic space and trachea to keep the laryngotracheal space open widely. After one month and a half, the silicon membrane and silicon tube were removed and a silicon T-tube was inserted instead of the silicon tube. The anterior wall of the laryngotracheal space was closed using a hinge flap. The patient can vocalize and does not complain of dyspnea at present, one year after the removal of the T-tube.
In order to examine the influence of infrasound that is becoming topical in society, human beings and guinea pigs were exposed to infrasound. After exposure, the hearing level, vestibular functions and autonomic nervous functions of human beings were examined, and endocochlear potential (EP) and cochlear microphonics (CM) of guinea pigs were examined. Next, after guinea pigs were exposed to intense audible low frequency sound that was born secondarily from infrasound and/or vibration of whole body concerning about air pressure change of infrasound, their EP and CM were examined. The results obtained were as follows : 1) By exposure of infrasound 10-15Hz 130-135dB LSPL for 30min. to human beings, their hearing level, vestibular functions and autonomic nervous functions were not changed. 2) After exposure of infrasound 15Hz 135-140dB LSPL for 24hrs.-72hrs. to guinea pigs, their EP and CM remained normal. 3) After each exposure of audible low frequency sound 90Hz 120dB SPL for 72hrs., 150Hz 110dB SPL for 72hrs. and 200Hz 100dB SPL for 72hrs. to guinea pigs, their EP became abnormal though their CM remained normal. 4) After exposure of 15Hz 500-30 vibration for 72hrs. to guinea pigs, both EP and CM remained normal. 5) After exposure of both audible low frequency sound 150Hz 100dB SPL and vibration 15Hz 500-30 for 72hrs. to guinea pigs, their EP became abnormal though their CM remained normal.
Changes in optokinetic nystagmus by age were assessed, and preparation of reference values by age was made by the use of the data from 834 reference subjects. As a result, changes by age were observed at the test on optokinetic nystagmus. The reference values by these changes can be approximated with the quadratic and was considered, therefore, to be useful clinically. Four parameters were set for the test items for optokinetic nystagmus as the total number of nystagmus (NYS) ; the mean of eye velocity during the fast phase of nystagmus (FM) ; the algebraic summations of eye velocity (VEL) and amplitude (AMP) during the slow phase of nystagmus. As the process for statistical analysis, variables were divided into 7 groups, and after removing outlier (any extraneous data) in each group, changes in variables by age were assesed by the one-way analysis of variance and the method of multiple comparison (Ryan's method). As a result : 1) the age group of each variable seemed to develope into normal distribution ; 2) it was presumed that change in NYS by age is less; 3-1) regarding FM, VEL and AMP, no change was observed in the variable by ages on 30s and 40s; and 3-2) however, decrease in the measured value was observed in ages on 60s along with aging. From these, the ages on 50s are the generation when the measured values of optokinetic nystagmus change. On the other hand, the reference values calculated, taking age into consideration, could be approximated with the quadratic. The Chi-square test with degree of freedom of 1 was found significant with 99% probability between reference and abnormal values by use of the quadratic of each variable. The discrimination of abnormal values as a result of testing optokinetic nystagmus seemed to be possible by the use of these reference values.
Complex accelerative stimuli can induce pica in rats as well as the treatment with poisons, which means eating of non-nutritive substances such as kaolin, in proportion to the severity of their sickness. For the purpose of using pica as an index of motion sickness in rats, we examined what kind of rotaion was effective for inducing pica in rats with or without normal bilateral labyrinth functions. Clinically potent anti-motion sickness drugs, such as scopolamine, methamphetamine, diphenhydramine, were examined in reducing rotation-induced pica in rats. Rats ate more kaolin after double rotation with continuously changing acceleration, than after single rotation. Both the animals treated with anti-motion sickness drugs or labyrinthectomy ate less kaolin even after double rotation. Since the physiological and pharmacological mechanisms for inducing pica in rats were similar with those of motion sickness in humans, pica in rats should be an acceptable index of their motion sickness. In order to study neural mechanisms of motion sickness in rats, we examined the effects of an anti-cholinergic as a potent anti-motion sickness drug and cholinergics as an antagonistic drug treated during the 4th-7th day of rotation on both habituation to double rotation within daily rotations for 10-11 days, using pica as an index of motion sickness. Rats were separated into three groups according to their initial susceptibility, and rats with low susceptibility were omitted in these experiments. Scopolamine (TTS-scopolamine) as an anticholinergic facilitated habituation to motion, especially in rats with moderate susceptibility. Treatment of physostigmine suppressed residual habituation to motion sickness in rats, especially with moderate susceptibility, though neostigmine, peripherally acting anti-cholinesterase, had no effect. These results suggested that centrally acting acetylcholine play an important role in suppressing habituation of motion sickness. In conclusion, rats should be a convenient model for studying for motion sickness, as we examined one of the neural mechanisms in motion sickness using pica as an index .
A retrospective investigation by ABR and COG was performed to children with bain impairment determined by neurological follow-up out of children who had hearing screening test, and the relationship with the presence or not of hearing loss was analyzed. The results obtained are as follows. 1) The failure rate in COG test was 46.3% in the brain impairment group. It was significantly higher than in the hearing loss high-risk group and the low-risk group. However, 20% of 101 children with brain impairment ware cases in which the COG test could not be performed. Presumability, this is due to the special character of COG test. 2) In the brain impairment children group, the rate of true positive, true negative and false negative by COG as to the presence or not of hearing loss stood at 68. 8%, 31. 3%, and 0% respectively. Since, however, 32.4% of the children who failed to pass COG had hearing loss, the usefullness of COG can be said to be high. 3) The incidence of hearing loss was significantly high at 15. 0% in the brain impairment group compared with other groups. In contrast, the rate of true positive was significantly high, the rate of true negative sigsaficantly low and no false negative was noted in the low-risk group. So COG was considered appropriate as a hearing screening device that can be used from the neonatal period. 4) In the brain impairment group, the rate of true positive by ABR was high at 86. 7%, but the rate of true negative was 13%. That is cases that have no hearing loss but do not pass ABR were noted in the brain impairment group. 5) As for the cases that failed inioial ABR and were suspected of hearing loss but eventually diagnosed as having no hearing loss, they all passed COF performed earlier. As for the cases of hearing loss, they all failed to pass COG. So, judgement of "pass" in the preceding COG can be a foundation on which to rule out hearing loss. 6) Eleven out of 13 children in the brain impairment group who failed to pass both COG and ABR had hearing loss. The effciency of hearing loss screening could be raised by combining the tests.