Pitch match and loudness balance tests were given to 397 cases with tinnitus. The factors which influenced tinnitus pitch and loudness were analyzed statistically from the clinical point of view.
The results obtained were as follows:
1) Onomatopoeia of tinnitus, either [Keeeen] or [Jeeeen], were observed in a majority of cases.
2) Significantly sharp sounding onomatopoeia such as [Keeeen] or [Meeeen] had high pitches, over 4kHz, and dull sounds like [Gooooh] or [Buuuun] had low pitches, below 500Hz.
3) Acute stage tinnitus, within one month of onset, had a significantly depressed pitch and walked loudness, above 6dB.
4) The pitches observed in cases with Meniere's disease and chronic otitis media were distributed evenly from low frequencies to high. In other cases, especially presbyacusis and noise deafness, high pitch tinnitus (above 4kHz) was frequently noted. The loudness of tinnitus without hearing loss was significantly greater than in other diseases.
5) As a rule the more deteriorated the hearing level was, the lower the frequency of the pitch, and the smaller the loudness in tinnitus.
6) A high pitch of tinnitus nearly corresponded with hearing type, that is, the pitch of tinnitus was also in accordance with the disturbed frequency in the hearing threshold.

View full abstract

A new strategic masking technique, namely the ABC method, has been developed. In performing this method of measuring thresholds of bone-conduction, the vibrator is placed at the forehead with both ears occluded by air-conduction earphones. One of the earphones is for masking noise and the other is a dummy which balances out the occlusive effect of the test ear against the nontest ear. The ABC method is based on the ABC rule that, in bone-conduction testing, the effective masking noise level necessary to block out the nontest ear can be calculated by a simple equation: right AC (A) +left AC (B) -unmasked BCu (C) under the assumption that the BCu belongs to the nontest ear. In some cases of hearing loss, the above noise level might produce overmasking, then an additive safety noise level, BCu + Interaural Attenuation, is employed. This method offers testers step by step directions which consist of indications of the noise level and a criterion for determining whether the measured bone-conduction is free from cross hearing and overmasking for the given configuration of air-conduction of both ears, BCu, and the masking noise level. Compared to the well known Plato method, in which measurements of thresholds are repeated at several masking noise levels in order to find a single bone-conduction threshold, the ABC method can essentially find the threshold at only one masking noise level. Therefore the ABC method makes it possible to save a great deal of time in performing bone conduction testing.

View full abstract

We immunohistochemically investigated the distributions of components of the basement membrane (BM) (type IV collagen and laminin) and alpha smooth muscle actin in twelve primary pleomorphic adenomas of the parotid gland, as compared with six recurrent benign pleomorphic tumors (recurrent type). There were no differences between the two types of the tumor in the distributions of the BM components and actin, whereas the recurrent type of tumor have numerous myxochondroid areas histologically. The localization of type IV collagen in the tumor tissue was almost the same as that of laminin. Actin was identified in the occasional myoepithelial cell. In the tumor tissues, the components of BM were most densely localized in the areas surrounding solid clusters of epithelial cells, outer cells of glandular structures and occasional cells in the myxoid area, but the stroma of the myxochondroid areas did not take up stain. BM was densely defined between the tumor capsule and epithelial cells, but the tumor capsule was not bordered by myxochondroid areas with BM.
These results suggest that loss of BM between the capsule and myxochondroid areas may be one of the causes of postoperative recurrence of pleomorphic adenomas.

View full abstract

There are conflicting views concerning middle ear infections due to Chlamydia trachomatis. To ascertain the etiological role of this agent in otitis media with effusion, middle ear effusions were cultured for C. trachomatis and other bacterial flora. A total of 102 patients with otitis media with effusion (OME) were recruited for this study. The study population included 66 patients with acute OME (AOME) and 36 patients with chronic OME (COME).
As Chlamydia pneumoniae, the third species of Chlamydia, is also known to be isolated from middle ear effusion of OME, the fluorescent-antibody technique using anti-C. pneumoniae or anti-C. trachomatis antibodies was employed in order to identify the inclusion bodies isolated on HeLa 229 cells as C. trachomatis.
C. trachomatis was recovered from 7 patients (10.6%) with AOME and from 8 (22.2%) patients with COME. Bacteria were cultured from 20 of 63 patients with AOME and from 13 of 28 patients with COME. Pathological bacteria were cultured from only 2 patients with C. trachomatis infection in the middle ear. Only normal skin flora, no bacterial pathogens, were isolated from the remainder.
Antibodies to C. trachomatis in serum were measured by a microimmunofluorescent method in 13 patients with C. trachomatis infection in the middle ear. Antichlamydial antibody of the IgG type was detected in 84.6% (11/13) of these patients.
These results suggest that C. trachomatis causes middle ear infections and plays an etiological role in the pathogenesis of otitis media with effusion.

View full abstract

Lymphoducts and blood vessels exist in the stroma, while none can be detected in the cancer nest itself within cancerous tissue. This explains why metastasis of carcinoma cannot occur without the escape of tumor cells through the basement membrane surrounding the cancer nest into the stroma. Accordingly, observation of the continuity of the basement membrane, what we call the cancer nest membrane, is essential for elucidating the first step of metastasis. Since type IV collagen is the most important structure composing the basement membrane, investigation of the immunohistological localization and continuity of type IV collagen is of value in predicting the metastatic aggressiveness of squamous cell carcinoma. We therefore studied biopsy tissues from the advancing lesion of head and neck squamous cell carcinoma in 95 untreated patients. The tissues were fixed in 85% ethanol and embedded in paraffin, and 5-um thin sections prepared were then immunohistochemically stained for type IV collagen by the ABC method for observation of the continuity status of the cancer nest membrane in relation to metastasis. The basement membranes of normal mucosal epithelium and normal interstitial capillaries were utilized as positive controls, and negative controls were obtained by using PBS in place of the primary antibodies for the immunohistochemical reaction. Membrane discontinuity (breaks or absence) correlated significantly with cervical lymph node metastasis, while intact membrane was associated with a low frequency of cervical lymph node metastasis. There was no obvious relation between the clinical T category and the continuity of the membrane; pN (+) carcinomas with membrane discontinuity included even T1 supraglottic and hypopharyngeal carcinomas, as well as T2 or higher oral mucosal carcinomas and T3 or higher glottic carcinomas, suggesting variation with tumor site. Hypopharyngeal and supraglottic carcinoma was associated with membrane discontinuity and a high incidence of cervical lymph node metastasis. On the other hand, glottic and oral carcinoma more often presented with intact membranes and had a lower incidence of metastasis, although carcinomas in these sites that did present with discontinuity of the membrane were associated with a high incidence of cervical metastasis. Therefore, observation of the continuity of the cancer nest membrane by the expression of type IV collagen may be useful in selecting better specific therapies and determining the necessity of prophyractic neck dissection. A correlation between the degree of tumor differentiation and the continuity of the membrane was also found; well-differentiated tumors with discontinuity of the membrane were frequently associated with cervical lymph node metastasis. No correlation was found between the nuclear DNA ploidy pattern and continuity of the membrane, but supraglottic and hypopharyngeal carcinomas were associated with both membrane discontinuity and an aneuploid DNA pattern. The relationship between membrane continuity and hematogenous distant metastasis remains to be studied.

View full abstract

Changes in nasal resistance were examined in 33 healthy subjects in order to investigate the physiological reactions of nasal mucosa to cold exposure. Each examinee was exposed to changes in room temperature from 25°C to 15°C with the same humidity in an artificial atmosphere chamber, regulated by an environmental control unit.
Nasal resistance was measured by means of the active-anterior method using a rhinomanometer MPR-2200. The same experiments were repeated on different dates in all 18 subjects.
The results can be summarized as follows.
1) The average value of nasal resistance significantly increased after room temperature was decreased from 25°C to 15°C.
2) Patterns of nasal resistance responses to cold exposure were classified into two types. One type was increased nasal resistance after cold exposure and the other was maintenance of resistance despite cold exposure. Each individual manifested a different pattern in experiments carried out on different dates.
3) The nasal resistance value in the chamber at 25°C was significantly higher in winter than in summer, and the increase in nasal resistance in response to cold exposure was significantly larger in summer than in winter. This result was assumed to be due to cold adaptation of the nasal mucosa in winter.
4) Heart rate decreased significantly with cold exposure. However, changes of heart rate in response to cold exposure did not correlate with changes in nasal resistance. No correlation between changes in nasal resistance in response to cold exposure and orthostatic loading, which was carried out after the cold exposure experiment, was detected.
5) A nasal cycle was observed in 7 (14%) of the 33 cases. In 6 of these total nasal resistance was maintained despite cold exposure.

View full abstract

We performed an immunohistological study of T-cell subsets and intercellular adhesion molecules in allergic and non-allergic nasal mucosa. In allergic mucosa, the number of CD4 positive cells tended to dominate that of CD8 positive cells. CD8 positive cells were detected randomly in all regions of the mucosa, whereas CD4 positive cells tended to be clusterd in the superficial portion of the lamina propria. Furthermore, the number of CD4 positive cells correlated with the intensity of ICAM-1 expression, especially in the superficial portion of the lamina propria.

View full abstract

In the treatment of head and neck carcinoma involving the carotid artery, resection of the carotid artery and direct reconstruction using a vein graft has commonly been employed to reduce the incidence of cerebral ischemic complications. But the procedure of carotid grafting itself carries the risk of preventing complete tumor clearance. And contamination due to salivary fistula, particulary in cases of meso or hypopharyngeal carcinoma, may result in graft rupture or thrombosis. To overcome these difficulties, the authors have developed a new surgical procedure, namely, a contralateral external carotid-middle cerebral artery bypass operation. This bypass system is designed at directly supplying the cerebral hemisphere on the carotid ligation side through a vein graft running entirely outside the cervical operative field. The vein graft is anastomosed end-to side to the external carotid artery of the opposite side. Then it is placed subcutaneously in front of the auricle, above the zygomatic arch, frontal subgaleal space and anastomosed end-to side to the recipient artery, the ascending branch of the middle cerebral artery, in the Broca area of the carotid ligation side. The neck is incised almost the same manner as in parotidectomy, with a slightly longer cervical extension, and the scalp by bilateral coronal incision of Sutta. A frontotemporal osteoplastic craniotomy of the involved side is performed. The length of the saphenous vein used is about 50cm. This surgical procedure requires no transient internal or external shunt. The common carotid artery can be ligated safely after confirming good post-anastomotic bypass flow using an electro-magnetic blood flow meter. Since 1990, four patients have undergone this surgery and none has developed serious neurological post-operative complications.

View full abstract

A 49-year-old male with spontaneous cerebrospinal fluid (CSF) otorrhea, an extremely rare condition, is presented as the third reported case in Japan. The patient visited us complaining of sudden hearing loss and fullness of the ear on the left side. A tegmen defect of the posterior cranial fossa and CSF leakage from the fistula into the mastoid air cells, but a normal inner ear, were found by means of metrizamide CT. The fistula was surgically occluded with fascia temporalis and an artificial bone with fibrin glue. The CSF otorrhea from the tegmen defect was successfully stopped by this procedure and no recurrence has been observed.
We discuss this extremely rare disease in this paper.

View full abstract

Whether temperature, pH, osmotic pressure, Ca²⁺, Mg²⁺, and ATP have promotive effects on ciliary activity was investigated by a photo-electric method using cultured human ethmoid sinus mucosa.
The results obtained were as follows:
1. Ciliary activity was reversible between 11 and 43°C. It was activated with rising temperature, and inactivated at 40°C. A temperature between 36 and 40°C was optimal for activation of ciliary activity.
2. In the case of brief immersion (30min.) in solutions between pH4.5 and 8.5 ciliary activity was reversible, and with prolonged immersion (72h) between pH6.5 and 7.5 it was also reversible. with brief immersion within 30 min, pH8.5 was an activating factor.
3. Ciliary activity was reversible in solutions between 143 and 1, 140mOsm/Kg for 30min. However, the ciliary reaction was different even at the same osmotic pressure according to the substance NaCl or glucose, used to adjust it. Inhibited beating was reversible after prolonged immersion (72h) in an osmotic pressure between 285 and 423mOsm/Kg adjusted by NaCl, and between 285 and 570mOsm/Kg adjusted by glucose. Any osmotic pressure of 428mOsm/Kg adjusted by NaCl activated ciliary activity.
4. Neither Ca²⁺ nor Mg²⁺, between 10^-2 and 10^-3 Mol, increased ciliary activity.
5. Between 10^-3 and 10^-5 Mol of Na-ATP, given exogenously, slightly activated ciliary movement, while Mg-ATP of 10^-3 Mol also activated it but only slightly.
It is important to bear in mind the above results in administering local aerosol therapy for nasal and paranasal sinus diseases.

View full abstract