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Volume 96, Issue 9
Displaying 1-18 of 18 articles from this issue
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MAKOTO OGASAWARA, TAKASHI TSUIKI, KAZUO MURAI, TERUAKI AIGAMI, TAKESHI ...1993 Volume 96 Issue 9 Pages 1395-1403,1573
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSIt is well known that reconstruction for discontinuity of the ossicular chain, without inflammatory disease, has a good prognosis.
Eleven cases of congenital ossicular chain malformation without ossicular fixation and 6 cases of ossicular chain injury due to the head trauma or an earpick, were treated surgically. The method of reconstruction and the prognoses, according to short-term and long-term follow up, were studied in these 17 cases.
The following results were obtained:
1) In almost all cases, the pure tone audiograms were flat or slightly rising types, and the mean air conductive hearing loss was about 60 dB. Only 2 cases showed the falling type with conductive hearing loss. Connective tissue was observed at the incudo-stapedial joint intraoperatively in these two cases.
2) Mean hearing improvement was in 31.8 dB in the low frequency region (125, 250, 500 Hz), 22.7 dB in the middle frequency region (500, 1000, 2000 Hz), and 12.9 dB in the high frequency region (2000, 4000, 8000 Hz), within 3 weeks after operation, in all 17 cases.
3) No clear changes in hearing level were seen posteroperatively, for the four periods evaluated; 1-3 weeks, 1-3 months, 4-6 months and over 7 months in all cases.
4) The cases in whom the reconstruction was performed between the incus and stapes, especially the foot plate of the stapes, showed poor hearing recovery.
5) There was no relation between hearing recovery and the prostheses used in reconstructions. However, it was thought that pieces of the patient's own cartilage or bone should be used whenever possible.View full abstractDownload PDF (801K) -
KAZUOKI KODERA, SADAYASU AKAI, EIKO HIROTA, MASAYOSHI MIURA, SUSUMU YA ...1993 Volume 96 Issue 9 Pages 1404-1409,1573
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSThe speech discrimination scores of a 57S word list were analyzed in 180 patients with sensorineural hearing loss. Confusion matrices were made on consonant groups of voiceless, voiced and nasal consonants. In succession, the incidence of consonants was compared between the 57S word list and Japanese conversation. Consonants with high incidence in Japanese conversation were t, h, d, g, m, and n. Patients with sensorineural hearing loss are apt to confuse t and hto k, dtoborr, gtob, dorr, mtonorr, and ntomorr. Itiseffective to correct these instances of consonant confusion, for improving conversational ability in Japanese patients with sensorineural hearing loss.View full abstractDownload PDF (543K) -
TAKUYA YAMAKAWA, HIROSHI YOSHIKAWA, ATSUSHI SAKURAI, GINICHIROU ICHIKA ...1993 Volume 96 Issue 9 Pages 1410-1416,1573
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSIntracranial activation of the facial nerve and the face-associated motor cortex are now possible with noninvasive magnetic stimulation techniques. Compound muscle action potentials (CMAPs) and the Blink reflex, in response to magnetic stimulation, were investigated. Subjects were 10 normal controls and 2 Bell's palsy patients. CMAPs were elicited in the orbicularis oris muscle by magnetic stimulation at the parieto-occipital skull and stylomastoid foramen. Furthermore, CMAPs were evoked by a magnetic coil oriented over the cortex. CMAP recording was possible with magnetic stimulation and the latenicies of CMAPs at the parieto-occipital skull were slightly greater than those at the stylomastoid foramen. In 10 normal subjects, the mean onset latency following transcranial magnetic stimulation of the facial nerve at the parieto-occipital skull was 5.07 msec (SD=0.40), while transcutaneous latency at the stylomastoid foramen was 2.77msec (SD=0.539). In the bink reflex, R1 latency was 10.99 msec (SD=1.27), ipsilateral-R2 latency was 37.46 msec (SD=2.57), and contralateral-R2 latency was 38.925 msec (SD=3.20). The blink reflex thus had a configuration similar to that evoked by conventional electrical stimulation. In the patients with Bell's palsy, CMAPs elicited by magnetic stimulation were of low amplitude with normal latency. However, in the blink reflex, only a contralateral R2 response could be recorded, and R1 and ipsilateral-R2 showed no response to stimulation at the affected side. Investigation of patients with Bell's palsy using this technique may therefore prove useful in the evaluation of peripheral facial nerve disorders.View full abstractDownload PDF (570K) -
MIKIKO FUKIYAMA, KOJI MATSUURA1993 Volume 96 Issue 9 Pages 1417-1422,1573
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSFrom 1986 to 1992, 61 adults with bilateral profound hearing loss visited our hospital for assessment as candidates for cochlear implantation.
The selection process consists of the following steps: 1) taking a clinical history, 2) general otological examinations, 3) pure tone audiometry 4) hearing aid evaluation, 5) promontory stimulation testing and 6) CT scans and MR Imaging of the temporal bone. We informed patients and their families of cochlear implantion as well.
Consequently 7 out of 61 cases (11.7%) were selected and underwent multi-channel cochlear implantation.
Twenty-eight cases were judged to have better hearing with a hearing aid because of a residual hearing. Twenty-one cases were considered to be inappropriate candidates after informing of the cochlear implant procedure.
Needless to say, the promontory stimulation testing and imaging studies are significant in patient selection, however, there was only a few who were excluded by these examinations.View full abstractDownload PDF (706K) -
MITSUGU KAWANAMI, NOBUKIYO SATO, MASAAKI KASHIWAMURA, EIJI CHIDA, MASA ...1993 Volume 96 Issue 9 Pages 1423-1429,1575
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSIn many studies, Evoked Otoacoustic Emissions (EOAEs) have been routinely documented in subjects with normal middle ear function showing tympanogram (TG) A type. However, middle ear dysfunction may influence the measurements of EOAEs. We investigated the EOAEs in ears with secretory otitis media (SOM) in order to understand the effects of middle ear dysfunction on EOAE measurements.
We present data from 73 SOM ears of 38 subjects aged 3 to 58 (mean=9.4years) and data from 61 ears of 54 subjects with sensorineural hearing loss as a control.
Generally, the EOAE thresholds of ears with mild sensorineural hearing loss have a good correlation with the audiometric hearing threshold level. On the other hand, the EOAE thresholds of ears with SOM were on the average higher than those expected from the audiometric hearing threshold level. In this paper, we classified TG B type further into TG B1 type and TG B2 type according to our criteria. Though neither TG B1type nor TG B2type revealed peaks in the tympanogram (-300mmH2O≤≤200mmH2O), the 2 groups differ in that TG B1 type seems to have its peak at pressures under -300mmH2O on tympanography while TG B2 type seems to have no peaks in that pressure range. As a consequence of this classification, most of the EOAE thresholds of SOM ears showing TG B2 type were scaled out (≥40 or 50 dB nHL).
Stimulus sounds from the earphone are transmitted from the external auditory canal into the inner ear, and EOAEs emitted from the inner ear transmitted through the middle ear into the external auditory canal. In other words, stimulus sounds and EOAEs pass through the middle ear in exiting or returning. The EOAE threshold in SOM ears may rise remarkably because the londness of the sound stimulus declines in the middle ear on the way to the inner ear and that of EOAE also declines in the middle ear on the way to the external auditory canal. In brief, we can state that each sound stimulus and EOAE decline in strength during the transmission process.
We conclude that even SOM ears with slight conductive hearing loss might manifest a significant elevation in the EOAE threshold, and that the outcome of EOAE measurement in routine examination must therefore be evaluated cautiously in making a proper clinical diagnosis.View full abstractDownload PDF (667K) -
AKIHIRO MATSUOKA, TETSUYA SHITARA, MAKITO OKAMOTO, KOZO FURUKAWA, HAJI ...1993 Volume 96 Issue 9 Pages 1430-1437,1575
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSIt has been reported that cholesteatoma is more aggressive in children than in adults and that it affects boys more often than girls. We found particularly prominent sex differences in the clinical characteristics and behavior of cholesteatoma in children, by comparing them with those of acute otitis media (AOM), otitis media with effusion (OME) and adult cholesteatoma. We retrospectively analyzed the clinical records of children diagnosed as having cholesteatoma by comparing their courses with those of AOM, OME, chronic otitis media, microtia and congenital malformation of the ossicles. The boy-dominant tendency were observed in OMA, OME, pediatric cholesteatoma, microtia and congenital malformation of the ossicles. Cholesteatoma has a tendency to fill the middle ear cleft in boys, in whom the most extensive cholesteatomas were observed. If OMA, OME, and cholesteatoma in children are considered to be a series of inflammatory middle ear diseases, a common factor must be involved in the boy-dominant tendency for this series of inflammatory middle ear diseases. We have proposed six factors contributing to sex differences in pediatric cholesteatoma. Among these, immunological, environmental and congenital factors were thought to be responsible for the sex differences.View full abstractDownload PDF (689K) -
KAZUO YAO, HIRO-OMI TAKAHASHI, MAKITO OKAMOTO, KOZO FURUKAWA, KATSUHID ...1993 Volume 96 Issue 9 Pages 1438-1446,1575
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSThe outcomes of 51 cases of nasopharyngeal carcinoma, treated in our hospital between July 1971 and June 1991, were evaluated. Factors which appeared to influence prognosis were assessed by the Kaplan-Meier method. The ages of the patients ranged from 18 to 74 years. There were 38 males and 13 females.
The cumulative five-year survival rate for the whole study population was 60.6%. The UICC classification (1987) was used for disease staging. The percentages of patients surviving after five years were: 100% (n=1) for stage II, 75% (n=4) for stage III, and 58.1% (n=46) stage IV. The histological type with the highest survival rate was poorly differentiated squamous cell carcinoma, which had a 69.8% (n=37) survival rate. The anatomical sites of primary tumors were the lateral wall (62.4%, n=33) and the posterior wall (54%, n=33). Percentages of patients according to classification based on initial therapy were as follows: Combined radiotherapy and chemotherapy group, 61.5% (n=22); radiotherapy alone group, 56.5% (n=22). The incidences of local recurrence according to initial therapy were 36% in the combined therapy group and 50% for the radiotherapy alone group. There were no metastases to the cervical lymph nodes after initial therapy in stage II and III. In stage IV, the rate of metastasis was lower when combined therapy was given. When the ralationship between initial therapy and distant metastasis was evaluated, the rate of metastasis was lower in the combined therapy group.
We conclude that combined therapy is necessary in the treatment of nasopharyngeal carcinoma. In addition, in view of the fact that impairment of immunological function characterizes this disease, immunotherapy should be included in the treatment regimen for carcinoma of the nasopharynx.View full abstractDownload PDF (757K) -
AN APPROACH WITHOUT FACIAL SCARRINGKUNIO NISHIKAWA, SHINJI NISHIOKA, KATSUYA AOJI, SATOSHI KOIKE, HIDEO N ...1993 Volume 96 Issue 9 Pages 1447-1456,1575
Published: September 20, 1993
Released on J-STAGE: March 19, 2009
JOURNAL FREE ACCESSSkull base surgery has been performed in 16 cases for en bloc resection of the nasal cavity and paranasal sinus carcinoma invading the anterior and middle skull base in our department.
The surgical approach to skull base surgery is mainly a combined craniofacial approach, which includes craniotomy via a coronal incision intracranially and a transfacial or transoral approach extracranially.
The direct transfacial approaches, such as lateral rhinotomy, Weber-Furguson incision, and midfacial split, resultin facial scarring. The midface degloving procedure was reported by Casson in 1974. This method can expose the midfacial skeleton by lifting the soft tissue from the face through an intraoral approach without external scarring.
The authors have modified Casson's facial degloving technique and applied it to skull base surgery. The entire cranium and facial skeleton can be extensively degloved by using coronal, gingival and conjunctival incisions.
Then, en bloc resection of the craniofacial compound segment can be accomplished through this degloving approach without external scarring of the face in anterior and middle skull base surgery.
The authors have performed this procedure in 2 cases, and proved it to be an extremely valuable technique, displaying excellent cosmetic and functional results with minimal complications.View full abstractDownload PDF (9883K) -
KATSUHIDE INAGI, HIRO-OMI TAKAHASHI1993 Volume 96 Issue 9 Pages 1457-1464,1577
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSThe etiology and clinical definition of intractable recurrent ulcer of the oral cavity and pharynx were long unknown. Then, intractable recurrent ulcer of the oral cavity and pharynx was defined as irregular ulcerative lesions occurring only in the oral cavity and pharynx, showing no specific findings in clinicohematological examinations, which recurred easily and were resistant to various treatments for at least one month. Twenty-five cases of intractable recurrent ulcer of the oral cavity and pharynx were treated in our hospital. Patient age, sex, chief complaint, past history, duration of illness, the locations and clinical findings of the ulcers, clinicohemological examinations, the pathology of the ulcers, therapy and prognosis were analysed. Disease specificity was found in age, sex, past history, locations and clinical findings of the ulcers, and prognosis. Our results suggest that intractable recurrent ulcer of the oral cavity and pharynx is a characteristic disease. The possibility that HLA-linked genetic factors play a role in the development of intractable recurrent which ulcers, which in addition to other factors, induce local immunoreaction which then prolongs the course of this disease, was suggested.View full abstractDownload PDF (788K) -
HIROYUKI YONEKAWA, MASAMI OHASHI, SOUJI MIYASHITA, MIZUHO GOTOH, SATOH ...1993 Volume 96 Issue 9 Pages 1465-1470,1577
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSThe current availability of 3 dimensional (3-D) imaging from Computed Tomography (CT) has yielded new anatomical information and pre-and postoperative evaluations.
However, little discussion as to the 3-D structural image of the temporal bone has been reported because conventional CT does provide sufficient data to produce such images.
The Helical scanning CT gathers continuous and multiple slice image data since it consists of an X-ray tube that continuously rotates around the patient while the patient moves continuously into the CT scanner.
Thus, application of the Helical scanning CT has made it possible to reconstruct 3-D images of the minute and complicated structure of the temporal bone.
We evaluated 3-D images from 9 typical cases, examined from February to October 1992.
As a result, we found that the 3-D images reconstructed with this system are useful for evaluation of the postoperative state of tympanoplasty, the diagnosis of anomalies of the bony labyrinth, and examining the extent of bone destruction induced by trauma, cholesteatoma, etc.View full abstractDownload PDF (3072K) -
DETERMINED BY CR AND CTTAKUMI MIYAZAKI1993 Volume 96 Issue 9 Pages 1471-1481,1577
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSDetection of calcification of the thyroid gland is very useful for the clinical diagnosis and therapy of thyroid cancer. In this study, we evaluated the usefulness of FCR (Fuji computed radiography) and CT by analyzing the correlation between the imaging findings of calcification and histological diagnosis. Fifty-one cases of follicular adenoma and 63 cases of differentiated carcinoma underwent FCR and CT. All cases undergoing operation received histological examination. Calcification was detected in 19.6% of follicular adenomas and in 46.0% of differentiated carcinomas by FCR, and 37.3% of follicular adenomas and in 63.5% of differentiated carcinomas by CT. Among cases without calcification on FCR, CT detected calcification in 26.7%. These differences between the results of FCR and CT were found in cases with small calcifications, low thyroid gland position and in whom differentiation between tracheal cartilage calcification and thyroid carcinoma calcification was difficult. In these cases, calcification was difficult to detect by FCR alone. Patients with follicular adenoma aged≥60 years showed a higher prevalence of calcification than younger patients. In cases of differentiated carcinoma, no relationship was seen between age and the prevalence of calcification. The classification of calcification shape by FCR showed that the majority of psammoma bodies, as well as sharp and irregular shapes, were found in differentiated carcinoma while round calcifications were found in follicular adenomas. On CT, calcification inside the tumor was found in 73.7% of follicular adenomas and in 92.5% of differentiated carcinomas.
FCR and CT are more useful for the detection of calcification than conventional radiography and are of great value in screening for thyroid tumors.View full abstractDownload PDF (8723K) -
YUMI FUJIWARA1993 Volume 96 Issue 9 Pages 1482-1489,1577
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSThe relationships between degrees of ototoxicity and the chemical structures of ototoxic drugs were investigated using isolated bullfrog semicircular canals. Thirteen derivatives of tuberactinomycin (Turn), a peptide antibiotic with pharmacological characteristics similar to those of kanamycin, were prepared by replacing the R1 branch with various amino acids. The degrees of ototoxicity were measured in these derivatives as well as in different kinds of aminoglycoside (AGs) antibiotics (TOB, GM, NTL, ISP, AMK). In order to measure the degree of ototoxicity, the ampullary nerve action potential of isolated bullfrog posterior semicircular canal, in response to mechanical endolymphatic flow, was recorded in Frog Ringer's solution and in the presence of different amounts of the various drugs. The degree of ototoxicity was determined by the amount of decrease in the maximal spike account. The degrees of ototoxicity of AGs were calculated to be in the order TOB>GM>ISP>AMK>NTL. This result was in agreement with those of previous morphological investigations. The derivatives of Turn with an R1 branch containing an acidic or a basic amino acid showed greater ototoxicities than those containing aliphatic side chains. The degree of ototoxicity of each drug tended to differ with each concentration, in both AG and Turn derivatives. Thus, the result indicate that chemical structure may be closely related to the degree of ototoxicity.View full abstractDownload PDF (697K) -
REIKO KURODA1993 Volume 96 Issue 9 Pages 1490-1500,1579
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSTraumatic perforation of the tympanic membrane (TM) was clinically studied by analyzing photographs of 231 ears treated in the Department of Otolaryngology of Tokyo Women's Medical College from May 1983 to December 1991. The dynamic features of TM and the mechanism of perforation are discussed.
Results and discussion:
1) Direct and indirect injuries of the TM through the external auditory canals were observed in 101 and 130 ears, respectively. One hundred and twenty-seven injured ears were seen in males and 104 in females. Subjects ages ranged from 1 to 64 years. One hundred and thirty ears were on the left side and 101 on the right.
2) Approximately 80% of the perforated regions were observed in the antero-inferior or postero-inferior quadrant.“Triangular-type”perforation was predominant among direct injuries and“slit type”among indirect injuries.
3) Approximately 80% of the cases had a TM defect area smaller than 20%.
4) One hundred and twenty of 127 ears which were treated within 7 days after injury were healed by conservative treatment. One hundred and four ears among these 120 ears healed spontaneously. The average healing period for these 104 ears was 25 days.
5) It was suggested that the age of patients and the defect area of TM were factors that delayed healing.
6) The minimum breakage stress of human normal TM (the right angle to the radial fibers of TM) was 13.7 gf/mm2.
7) It was presumed that the strain stress and shear stress of TM contributed to traumatic TM perforation in indirect injuries.View full abstractDownload PDF (1385K) -
MUNENAGA NAKAMIZO, SIN'ETSU KAMATA, KAZUYOSHI KAWABATA, HISAAKI TAKAHA ...1993 Volume 96 Issue 9 Pages 1501-1509,1579
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSIn a total of 2083 cases of hollow organ cancer of the head and neck region treated in our institute in the past 20 years, the relative risk of second primary cancers was statistically studied by the person-year approach. The organ association in multiple primary cancers and the relationship between tobacco and alcohol consumption and the development of second primary cancers were also reviewed.
The incidence of second primary cancers was significantly (p<0.05) higher in patients having a lesion at the tongue (n=502), mesopharynx (n=188), hypopharynx (n=224) and larynx (n=621) and in the oral cavity (n=203) than in the general population. With regard to organ association in multiple primary cancers, cancers in the oral cavity, esophagus and at the pharynx were found to occur as second primary cancers of the tongue, oral cavity, meso-hypopharynx and larynx at significantly high rates in males. Male laryngeal cancer was related to the lung. No relation of female lingual cancer to the esophagus was noted. The incidence of second primary cancer was very high in persons who had been heavy smokers and/or heavy drinkers before the occurrence of their primary cancer in the head and neck region. In these people, second primary cancers were found to occur at high rates as cancers related to tobacco smoking and drinking. Otherwise, in cases with head and neck cancers less related to tobacco smoking and drinking, the incidence of second primary cancers was low.
From the above results, tobacco smoking and drinking may be closely related to a high incidence of second primary cancer following the first primary cancer in the head and neck region.View full abstractDownload PDF (733K) -
1993 Volume 96 Issue 9 Pages 1510-1525
Published: September 20, 1993
Released on J-STAGE: December 22, 2010
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1993 Volume 96 Issue 9 Pages 1526-1536
Published: September 20, 1993
Released on J-STAGE: December 22, 2010
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1993 Volume 96 Issue 9 Pages 1537-1559
Published: September 20, 1993
Released on J-STAGE: December 22, 2010
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[in Japanese]1993 Volume 96 Issue 9 Pages 1560-1563
Published: September 20, 1993
Released on J-STAGE: October 22, 2010
JOURNAL FREE ACCESSDownload PDF (160K)
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