Inhalation of pure oxygen mixed with 5% CO₂ gas has been utilized as therapy in cases sudden sensorineural hearing loss.
Three patients in whom hearing was lost 44, 25 and 45 days, respectively, after the occurrence of sudden deafness and without improved hearing, showed a significant improvement in hearing after inhalation of this gas mixture. This therapy was also effective for patients observed soon after onset of hearing loss.

View full abstract

A 28-year-old woman with a slowly progressive ataxic gait was examined using routine neurological, CT scanning and equilibrium testing procedures. The following results were obtained:
1) Neurological examinations and CT scanning revealed that symptoms were due to a dysfunction of the cerebellum with lesions of both the vermis and hemisphere.
2) The spontaneous nystagmus tests revealed a peculiar nystagmus which was irregular and similar to a congenital nystagmus. Furthermore, the nystagmus altered its direction like a nystagmus alternans. A marked disturbance of the righting reflex, such as falling backwards was also observed.
From the results described in (1) and (2), the following conclusions were drawn:
(1) Symptoms were due to spino-cerebellar atrophy (Type of Déjèrine-Thomas), although the characteristics of spontaneous nystagmus were rather different from those of the nystagmus hitherto reported.
(2) The nystagmus referred to herein was attributed to lesions of the brain stem. In contrast, disturbance of the body reflex was attributable to lesions of the cerebellum, particularly the vermis.

View full abstract

Thirty five cases (thirty seven sides) of mucoceles in the fronto-ethmoidal region were studied using conventional X-ray films in Caldwell and Waters views. Polytome films in frontal and lateral sections were also included in the analysis. Cases were classified by the two methods. First classification comprises; postop. extranasal frontal sinusectomy, 11 sides, post. either endonasal or Caldwell-Luc operation, 15 sides, and no surgery (chronic sinusitis) 11 sides. Second classification is done according to the types of X-ray findings by the coventional views and comprises; type 1 (simple expanding type), 14 sides, type 2 (chronic sinusitis type), 19 sides, and type 3 (obliterated and cystic type), 4 sides. In the postop. extranasal cases, the distribution of types is as follows; type 1, 45%, type 2, 36%, and type 3, 18%. In the post op. either endonasal or Caldwell-Luc, type 1, 27%, type 2, 67%, and type 3, 7%. In no surgery, type 1, 45%, type 2, 45%, and type 3, 9%. The type 2, which shows no typical radiological signs for the frontal mucocele, occupies about 50% of the cases.
X ray-findings were analysed according to the sites in the frontal sinus, i. e., marginal portion, intrasinus portion and basal portion. In the marginal portion of the frontal mucocele, marginal sclerosis, either loss or incomplete absorption of the marginal scalloping were included in the analysis. The marginal sclerosis was also divided into three subdividions, i. e., linear, bandage-like and fading sclerosis. The distribution of the three subdivisions is as follows; linear, 51%, bandage-like, 5%, and fading, 43%.
The change in the marginal scalloping is as follows; complete loss, 46%, and incomplete absorption, 54%. In the intrasinus portion, increased radiolucency was seen in 43%, radiopacity in 46%, and irregular soft tissue in 16%. In the basal portion of the frontal mucocele, distortion of the superior orbital wall was seen in 16%, absence in 49%. Distortion of the medial orbital wall was seen in 35%, absence in 30%. Bulla frontalis was seen in 11% and lateral recess in 76%. Supraorbital extension of the mucocele was classified into, anterior one third, anterior two thirds, and the whole of the superior orbital wall. The distribution is, 51%, 38%, and 4% in that order. As the last roentgen sign for the basal portion, the anterior group of the ethmoid air cells was classified according to the radiolucency. Normal radiolucency was seen in 30% and increased radiopacity in 70%.
The most important clues for the correct diagnosis of the frontal mucocele are history and the conventional rhinological methods of examination. X-ray findings only assist in the diagnosis. Among the many X-ray signs, important ones are the changes in the marginal portion and in the basal portion. The presence of marginal sclerosis, changes in the marginal scalloping, either loss or distortion of the superior and the medial orbital walls, and the presence of bulla frontalis and lateral recess deserve special emphasis.

View full abstract

Epistaxis is considered to be a most important symptom in head and neck cancer. Twenty patients with nasal malignancy and 76 benign cases visited our tumor clinic of Tokyo University Hospital during the period of November 1972 to October 1977. Nine cancer patients (45%) and 41 benign cases (54%) complained of epistaxis. As benign cases included eight patients whose only symptom was epistaxis and seven who revealed an angioma or angiofibroma, epistaxis was more frequent in benign than in cancer ones. The chief complaint in 30% of both groups (six cancer and 23 benign) was epistaxis.
As for malignancy of paranasal sinuses, we observed 144 patients with cancer and 200 benign cases during the same period. In fifty-nine cancer patients (41%) and 48 cases of a benign occurrence (24%) complained of epistaxis. Twenty (14%) and ten (5%) had epistaxis as chief complaint, respectively.
There were 76 patients with nasopharyngeal cancer and 61 benign cases during the period. Twenty-one (28%) and nine (15%) complained of severe epistaxis, and six (8%) and six (10%) had the symptom as the chief complaint. Benign cases included four with angioma or angiofibroma.
In total, 187 patients had epistaxis and 89 of them (48%) revealed nasal, paranasal or nasopharyngeal malignancy. The chief complaint of 71 cases was epistaxis and 32 (45%) had cancer.
During the same five years, 478 patients visited our emergency clinic because of epistaxis and 74 required institutional treatment. Head and/or neck cancer was not demonstrated in any of these patients.
Epistaxis due to head and neck cancer is not massive, but is continuous. Patients with epistaxis should always be examined carefully even if the bleeding is not severe.

View full abstract

A 82-year-old man complained of a hoarseness of a four months duration.
Indirect laryngoscope revealed a non-ulcerated tumor mass lesion involving an arytenoid lesion. The mass was surgically extirpated and histologically, tumor cell nests were composed of numerous cystic spaces and solid proliferation.
Ultrastructurally, in the cystic pattern, a basal lamina adjacent to the surrounding epithelial cells was seen and the intermediate zone was composed of stellate or round granules and the central core of a bundle of densely packed collagen fibrils. The cytoplasm of neoplastic epithelial cell contained filaments, rough endoplasmic reticulum, free ribosomes, and dense secretory granules. In the solid pattern, small desmosomes and intercellular spaces were observed and occasionally small cystic spaces and mitosis were evident.
This tumor was thus diagnosed as an adenoid cystic carcinoma.

View full abstract

One hundred and seventy patients with recurrent laryngeal nerve palsy were investigated. Males was more frequently affected. One hundred cases (59%) were studied etiologically. The most frequent etiological factor was thyroid cancer which was evident in 31 cases. Hoarseness was the most frequent complaint and only 3 patients complained of dyspnea. In 155 cases, the vocal cords were affected unilaterally, 110 cases on the left side, 45 on the right side, and 15 cases bilaterally. Conservative or surgical treatments were applied. Among conservative treatments, administration of steroids was effective for certain groups with recurrent laryngeal nerve palsy induced by intratracheal intubation and common cold. Intracordal injection of silicone or Woodman's operation was indicated for some patients followed-up conservatively for about 6 months or more without improvement.

View full abstract

The search for radiopharmaceuticals with an affinity for malignant tumors has been continuous but to date there has been no effective compound available. We used ²⁰¹Tl chloride for head and neck tumor scanning and made scintigrams.
Each patient was given 2mCi of ²⁰¹TlCl i. v. and scintiscans were made for 5 min. after injection. The apparatus used was a Nuclear Chicago's Pho-Gamma HP and the present count was 200K.
In normal cases, ²⁰¹TlCl was incorporated into the nasal cavity, nasopharynx, oral cavity, salivary gland, and thyroid gland.
Among the 11 cases of head and neck malignant tumors, 7 cases, including cancer of the maxillary sinus, inverted papilloma of the maxillary sinus, cancer of the tonsil and cancer of larynx reacted positively to the scanning.
In these 7 cases, a scanning with ⁵⁷Co-BLM was also positive.
In some cases, the affected area and the physiological accumulation of ²⁰¹TlCl overlapped and assessment of the scintiscans was difficult. The advantages of ²⁰¹TlCl are as follows:
(1) ²⁰¹TlCl does not accumulate in bones.
(2) Scanning can be started 5min. after injection and the result can be obtained in twenty or thirty minutes.
²⁰¹TlCl is a nuclide considered to be applicable to malignant tumors in the head and neck areas.

View full abstract

The mechanisms of host resistance against the bacterial or viral infection located in the upper respiratory tract were studied with special reference to lysozyme, sialic acid and interferon. The activity of lysozyme was found to be high in the nasal secretion and saliva, while that of the tonsil was low. The sialic acid, a receptor for myxovirus, was also detected in high amount in the nasal secretion. Considering the increase in response to infection, we found that lysozyme and sialic acid played an important defensive role in bacterial or viral infections in the upper respiratory tract.
Interferon, a naturally-occurring broad-spectrum antiviral factor, was observed to protect against the deterioration of the ciliary movement of the nasal mucosa caused by viral injection.
Importance of local nonspecific host-resistant mechanisms including the abovementioned factors was emphasized, as well as that of specific immunological mechanisms against the upper respiratory tract infection.

View full abstract