There have been few reports on tortuosity of the internal carotid exhibiting pulsation or swelling in the pharyngeal wall. Because this disease carries the risk of causing massive hemorrhage at the time of incision of a peritonsillar abscess, surgical treatment of the adenoids, or tonsillectomy, otolaryngologists should be aware of the existence of this disorder as a risk facter.
We encountered tortuosity of the internal carotid in the pharynx in 18 cases over an approximately two year period. Females (15 cases) outnumbered males (3 cases), and the mean age was 68 years at the time of diagnosis. There was no right-to-left difference in terms of the incidence of the disease. The complication of hypertension was noted in 10 cases. MR-Angiography (MRA) was performed in 13 cases, and very clear images were obtained; this technique was useful for diagnosing this disorder.
For the most part, contrast angiography has been employed for the diagnosis of this disorder, but various complications, including deaths, have been reported. As the incidence of tortuosity of the internal carotid is high in the elderly, it is thought that any complication which may occur has the potential to become serious. Non-invasive diagnostic techniques are thus recommended. MRA is absolutely non-invasive, and we therefore believe that this technique should be the modality of first choice for diagnosing tortuosity of the internal carotid.

View full abstract

The reliability of brainstem evoked response audiometry (ERA) as an objective audiometric study was evaluated in long term follow-up infants with moderate to severe sensorineural hearing loss. None of the infants had either brain damage (cerebral palsy, mental retardation) or other severe complications (genetis diseases). The thresholds of ERA at 1kHz and 4kHz were measured in 234 infants below one year of age, from 1983 to 1990, in our hospital. These infants were followed-up to the age when conditioned oriented response audiometry (COR) and play audiometry could be conducted. Pure tone thresholds obtained by COR and play audiometry were compared with those of ERA. In addition, speech problems in these patients were evaluated. In all of those infants, hearing aids were fitted before one year of age to achive early habilitation. As a results, ERA was found to be a reliable and efficacious test for determining auditory thresholds, and providing hearing aids for early habilitation in one-year old infants with moderate to severe sensorineural hearing loss.

View full abstract

An immunohistochemical study using a panel of monoclonal antibodies (mAbs) against blood group A, B, H and Lewis antigens Le^a, Le^b, Le^x and Le^y and lectins, such as PNA, VVA-B4 and UEA-1, was carried out to investigate the aberrant expression of carbohydrate antigens in formalinfixed, paraffin-embedded tissue sections of thyroid neoplasms. The tissues examined consisted of 26 papillary carcinomas, seven follicular adenomas, seven follicular carcinomas, one anaplastic carcinoma and one medullary carcinoma.
MAbs against A, B and H antigens reacted strongly with papillary carcinomas from most of the individuals studied (22 of 26 individuals) and their reactivity corresponded well to the blood groups of individuals. In follicular adenomas and carcinomas, these mAbs reacted weakly with a small number of neoplastic cells from two of seven, and four of seven individuals, respectively. Positive staining with mAbs against Le^a and Le^b antigens was found in almost all papillary carcinomas. On the contrary, these mAbs rarely reacted with cells from follicular adenomas and carcinomas. T and Tn antigens which were recognized by PNA and VVA-B₄, respectively, were only weakly expressed in a limited number of cells from the thyroid neoplasms. Normal cells adjacent to malignant cells were not stained by any of the stains used in this study.
These results are discussed in light of our recent findings that polylactosamine structures produced in papillary carcinomas are quite different from those expressed in other types of neoplasms.

View full abstract

To examine the roles of α-adrenergic, β-adrenergic and cholinergic agonists on the nasal secretion mechanism, the author repeated nasal methacholine (Mch, 1 time 20mg) challenges ten times at 10-min intervals in 13 healthy male subjects. As it was difficult to obtain a sufficient amount of nasal secretion for analysis using simple nasal provocation tests with α-and β-adrenergic agonists before repeated Mch challenges, α-adrenergic (phenylephrine, Phe, 2mg) and β-adrenergic (isoproterenol, Iso, 0.2mg) agonists were administered into both nostrils. The effects of these agents on the volume of nasal secretions (Vol), the fucose volume (Fu, an index of glandular secretion) and the albumin volume (Alb, an index of vascular permeability) in the Mch induced nasal secretions were analyzed each time. Repeated Mch challenges revealed that the initial challenge produced the largest response as reflected by the Vol, Fu and Alb of the secretions, and by Vol and Fu production being almost constant during the 10 repetitions of Mch challenge at 10-min intervals. However, Alb demonstrated the greatest decrements. Phe administration before Mch challenges gave rise to Fu increasing more markedly while Alb was unchanged. On the other hand, that of Iso before, produced greater decreases in Vol, Fu and Alb levels. Therefore, it is suggested that repeated Mch challenge causes the maintenance of glandular secretion while stopping albumin permeability, that with pre-administration of α-agonists glandular secretion increases, and that pre-administration of β-agonists inhibits glandular secretion. When both α-and β-agonists are given before the challenge, however, there is no increase in vascular permeability.

View full abstract

In patients with HIV infection, oral and pharyngeal pathology frequently occurs, but there have been no reports on cases of deafness in Japan. Herein, the authors report two cases of sensory neural hearing loss in hemophilia A patients infected with HIV through factor VIII concentrates.
Case 1 was a 16-year-old male with hemophilia A. He had been administered factor VIII concentrates starting at 6 months after birth. At 8 years of age, HIV antibodies were positive. He was diagnosed as having AIDS after suffering from pneumocystis carinii. He complained of right otalgia and slight vertigo during treatment for a relapse of the penumocystis carinii. He underwest otological examinations at our department. The right tympanic membrane showed opacification and serous otorrhea was noted. Acute otitis media was diagnosed and tympanotomy was conducted. Afterwards, the right tympanic membrane developed a large perforation and sensory neural hearing loss occurred.
Case 2 was a 49-year-old male with hemophilia A. He had been administered factor VIII concentrates from the age of 23 years. At 48 years of age, HIV antibodies were positive. The patient complained of sudden deafness in the right ear and slight vertigo. He underwest otological examinations at our department. The tympanic membrane was normal bilaterally, but sensory neural hearing loss was found in the right ear.
It was presumed that acute otitis media directly involving the inner ear had caused a perceptive disorder in case 1 while a pattern of sudden onset of deafness was apparent in case 2.

View full abstract

Since 1990, in treating 10 cases with head and neck tumors which had invaded the carotid artery, the authors have performed vascular reconstruction of the carotid artery. The standard surgical procedure is en bloc resection of the tumor and carotid artery and one stage ipsilateral vascular reconstruction of the carotid artery at cervical operation using a temporary shunt tube. When the tumor is located in a distal or proximal cervical portion, craniotomy or thoracotomy is needed in addition to the usual surgical procedure. The author classifies one stage ipsilateral reconstruction of the carotid artery into four types, depending on the anastomotic site, and describes distal or proximal limits of this procedure at cervical operation.
Type A: Cervical operation after partial resection of the carotid wall; Patch angioplasty or simple arteriorrhaphy.
Type B: Cervical operation after round resection of the carotid wall; Common carotid-internal carotid artery graft interposition, etc.
Type C: Using craniotomy in addition to the cervical operation; Common carotid-middle cerebral artery bypass, etc.
Type D: Using thoracotomy in addition to the cervical operation; Transthoracic subclavianinternal carotid artery bypass, etc.
The design of the operative technique and adjunct enable distal or proximal limits of this procedure to be expanded. It is necessary to discuss the limits of this procedure in each case. Selecting an adequate surgical procedure based on intraoperative findings reguires close teamwork with neurosurgeons and thoracic surgeons.

View full abstract

To obtain an early prognostic diagnosis of patients with peripheral facial palsy, a magnetic stimulator (Dantec Mag 2) was used to directly stimulate the intracranial portion of the facial nerve in 15 normal subjects and 108 patients with peripheral facial palsy.
In normal subjects and patients with facial palsy, compound muscle action potentials (CMAPs) of the orbicularis oris muscle elicited by transcranial magnetic stimulation were compared with CMAPs elicited by electrical stimulation at a peripheral site of the stylomastoid foramen. This technique is similar to electroneurography (ENoG) and is regularly used in our department. In normal subjects, the latency of magnetically evoked CMAPs was longer (1.0ms, SD 0.39ms) than that of CMAPs evoked by electrical stimulation.
There were two categories of patients; the first group consisted of patients who visited our hospital within 2 weeks after palsy onset with a record of electrically evoked CMAPs (ENoG) and magnetically evoked CMAPs, the second group consisted of all others. The first group was then divided into four subgroups based on minimal ENoG values obtained within 2 weeks after the onset of palsy.
In patients, ENoG values declined until the seventh day after palsy onset, and then plateaued. However, the amplitude ratio of magnetically evoked CMAPs between the affected side and normal side showed no tendency to deline until the seventh day after palsy onset. Thus, whether magnetically evoked CMAPs could be recorded must be discussed in relation to the prognosis of facial palsy. The patients in whom magnetically evoked CMAPs could be recorded within the seven days after the onset of palsy were classified into a group in which the minimal ENoG value was greater than 20%. These patients recovered almost 2 months after the onset of palsy, and were significantly better than the recovery rates of those patients in whom magnetically evoked CMAPs could not be recorded.
The site at which the facial nerve is magnetically stimulated remains controversial. In patients with peripheral facial palsy, recovery of the stapedial reflex, blink reflex and magnetically evoked CMAPs were examined to investigate the site of magnetic stimulation. From the clinical perspective, the facial nerve is thought to be magnetically stimulated near the meatal foramen that Fisch reported the site of damage in Bell's palsy. This stimulation site was almost the same point as that calculated from the mean latency difference between magnetically evoked CMAPs and ENoG in normal controls.

View full abstract

We divided people more than 65 years of age into groups, by 5-year age intervals, and performed hearing tests based on pure tone, speech sound, and inner ear and retrocochlear hearing functions. Thus, we studied the mechanism of hearing disorder progression with aging in an attempt to identify factors involved in decreased speech sound recognition. The following results were obtained.
1. The regression coefficient of speech discrimination ability and the mean hearing threshold level were greater in the elderly patients than in the younger patients with cochlear hearing loss.
2. Abnormal decreases in speech discrimination ability evaluated on the basis of the mean hearing threshold level occur more frequently with advancing age.
3. The SISI score increased rapidly in patients 80 years of age or older.
4. Directional hearing function (interaural time difference threshold) varied more markedly with age.
5. Little difference in SSB clipping speech articulation was seen among elderly subjects less than 80 years old, though scores were lower than those of the control group. However, it was decreased in patients 80 or more years old.
These results show that the effect of a raised pure-tone hearing threshold due to decreased inner ear function and the effect of recruitment phenomenon on speech hearing were the same in patients from 65 to the late 70s; however, the effect of retrocochlear hearing loss clearly increased with age. Therefore, we consider patients 80 or more years old, to have an impaired inner ear function which is aggravated and that this, in association with advanced retrocochlear disturbance, leads to greatly decreased speech discrimination ability.

View full abstract