Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 74, Issue 5special
Displaying 1-47 of 47 articles from this issue
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  • A Long-term Follow-up Study of Middle Ear Surgery
    Conducted in the 11 years from 1968 to 1978
    Kotaro Ukai, Yasuro Miyoshi, Yasuo Sakakura, Mikikazu Yamagiwa, Yuichi ...
    1981 Volume 74 Issue 5special Pages 913-920
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_913
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    The purpose of this study was to analyze the results of the long-term follow up of the 325 ears operated upon during the 11 years from 1968 to 1978. According to the 166 patients who answered our questionnaire, ear discharge was complained of in 45 percent of the cases and hearing deterioration in 65 percent thereof.
    In a total of 115 ears, on which we were able to carry out otoscopic examination and pure-tone audiometry, 49 percent underwent surgery for cholesteatoma; 42 percent, for chronic supperative otitis media; 4 percent, for tuberculosis of the middle ear; and 5 percent received surgery a second time on the middle ear. Of those, 46 ears underwent intact canal wall tympanoplasty; 32 ears, classical tympanoplasty; 19 ears, modified radical mastoidectomy; and 18 ears, radical mastoidectomy.
    Recurrence of perforation of the reconstructed ear drum was found in 44.7 percent and recurrence of ear discharge was present in 43 percent of the total; in 61 percent of the ears that had received radical mastoidectomy, in 47 percent of those with modified radical mastoidectomy in 56 percent of those with classical tympanoplasty and in 24 percent of those with intact canal wall tympanoplasty. Long-term hearing results were unsatisfactory; only 18.4 percent of the patients experienced improvement in postoperative hearing but postoperative hearing was depressed in 40 percent of the cases.
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  • Statistical Observation of Patients with Vertigo in our Clinic
    Seiichiro Yoshii, Yasuro Miyoshi, Yasuo Sakakura, Yuichi Majima, Keizo ...
    1981 Volume 74 Issue 5special Pages 921-927
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_921
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    We analysed the outpatients who complained of vertigo and dizziness in our clinic from 1975 to 1979.
    The results are as follows.
    1) The number of patients with vertigo and dizziness was 1.7-2.7% of the total number of patients.
    2) The causes of vertigo or dizziness were peripheral disorder (32%), central lesions (18%) and those of unknown origin (46%). Meniere's disease consisted of 8% of the peripheral disorders.
    3) Among the vestibular tests, abnormal findings were detected most frequently by the standing test (45%) and the presence of spontaneous nystagmus (35%).
    4) Regarding age, the peak was found in the 40's.
    5) We clearly demonstrated that the O. K. P. test and E. T. T. test were of the greatest value for diagnosis.
    6) The occurrence of CP in the caloric test was the clearest indication of a peripheral disorder.
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  • A Clinical Study of Facial Palsy
    Mikikazu Yamagiwa, Yasuro Miyoshi, Yasuo Sakakura, Hiroyuki Nishioka, ...
    1981 Volume 74 Issue 5special Pages 928-937
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_928
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    A consecutive series of 96 patients with facial palsy in the Department of Otolaryngology, Mie University Hospital was studied clinically during the two years from 1978 to 1979. There were 60 cases of Bell's palsy, 14 cases of Hunt's syndrome, 15 cases of posttraumatic palsy and 7 cases of intracranial vascular lesions and of head and neck malignancies. For the treatment of patients with Bell's palsy and Hunt's syndrome, peroral steroid and massive doses of intravenous ATP were used fundamentally and the following results were obtained.
    1. Seventy per cent of the patients with Bell's palsy and 42.9% of those with Hunt's syndrome were cured completely.
    2. The younger the patients were and the shorter the duration from the onset of disease to the start of treatment was, the higher the rate of complete cure.
    3. Several bizarre phenomena resulting from misdirected reinnervation, such as crocodile tears, synkinesis or twitching in the mimic muscles, were observed in 76.9% of the patients with incomplete cure.
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  • A Clinical Study of Dysosmia
    Mikikazu Yamagiwa, Yasuro Miyoshi, Yasuo Sakakura, Seiji Yamada, Hiroy ...
    1981 Volume 74 Issue 5special Pages 938-947
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_938
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    A consecutive series of 107 patients with dysosmia in the Department of Otolaryngology, Mie University Hospital during the four years from 1974 to 1977 was studied clinically. The pernasal olfaction test with exponentially diluted odors of five kinds (beta-phenyl ethyl alcohol, cyclotene, iso-valeric acid, gamma-undecalactone and scatol), which had been standardized by the task group for olfaction in Japan, was employed for evaluating the olfactory acuity of the patients. Of the 107 patients, 76 were anosmic, 23 were hyposmic and 8 were parosmic. Pathogenesis of dysosmia were analysed by the patient's history and symptoms, rhinoscopic and radiographic findings of the nose and the intravenous olfaction test, and could be classified into the four groups of respiratory disturbance (R), peripheral nerve disturbance (P), combination of respiratory disturbance and peripheral nerve disturbance (R+P) and central nervous disturbance (C). There were 20 patients with R, 14 with P, 53 with R+P and 20 with C. For patients with R or R+P, therapy with nasal drops containing steroid solution was conducted while the patient was lying supine with the head bent far backward. By this treatment, 85% of the patients with R and 75.5% of those with R+P were improved. However, there were no efficacious therapies for patients with C or P.
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  • Long-term effect of immunotherapy on nasal allergy
    Yukiko Ito, Yasuo Sakakura, Kotaro Ukai, Yuichi Majima, Hiroshi Mitui, ...
    1981 Volume 74 Issue 5special Pages 948-958
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_948
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    One hundred and twenty-two patients (treated group) with allergic perennial rhinitis completed a one to six-year course of hyposensitization treatment with house dust extracts. Seventeen allergic patients (interrupted group) who received immunotherapy for 11 to 38 months with a mean of 25 months had interruption of treatment for 6 to 43 months with a mean of 17 months. Clinical significance of immunotherapy has been evaluated by comparing the duration of treatment with the following parameters: nasal symptoms and signs, nasal provocation test and skin test against house dust, numbers of eosinophils in nasal secretion and blood, concentration of specific and nonspecific serum IgE, and blocking antibody activity.
    In patients with severe or moderate symptoms, improvement in nasal symptoms was found in 74% of 84 patients of the treated group and 90% of 10 of the interrupted group. There was a correlation between the duration of treatment and the ratio of improvement in nasal symptoms in the treated group. Improvement in nasal symptoms in the interrupted group was present for at least one year. There was no correlation between the duration of treatment and the clinical findings except blood eosinophilia. Although the blocking antibody activity had been found in 13% of the patients prior to immunotherapy, it was found in 58% of the treated group and 35% of the interrupted group after therapy. There was a statistically significant difference between the treated and nontreated groups. There was a correlation between the appearance of blocking antibody and the duration of treatment but the appearance did not correlate with the improvement of nasal symptoms.
    These findings suggest that continuation of immunotherapy with house dust extracts for one and a half to two years in patients with severe or moderate nasal allergic symptoms is recommendable and after completion of this course the clinical symptoms may be maintained of the improved level for more than one year.
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  • Clinical Study of Malignant Tumors of the Nose and Paranasal Sinuses
    A 26-year Survey
    Fumi Hamaguchi, Yasuro Miyoshi, Yasuo Sakakura, Kotaro Ukai, Mikikazu ...
    1981 Volume 74 Issue 5special Pages 959-971
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_959
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    Two hundred and eighty-seven patients with malignant tumor of the nose and paranasal sinuses were treated at the Department of Otolaryngology, Mie University Hospital, during the 26 years from 1955 to 1980.
    These cases were analysed clinically and the following results were obtained.
    1. There were 256 cases (89.2%) of malignant tumor which originated in the maxillary sinus, 24 cases (8.4%) in the nasal cavity, 5 (1.7%) in the ethmoid sinus, 2 in the frontal sinus and 1 in the sphenoid sinus.
    2. There were 170 males and 117 females (1.45:1) and the majority of the patients were distributed by age in the 6th, 5th and 7th decades of life.
    3. Swelling of the cheek was the most common and characteristic symptom of maxillary tumor. Nasal obstruction was most commonly encountered in the case of the tumor of the nasal cavity.
    4. The crude five-year survival rate of all the cases was 28.6%. Histopathologically, the prognosis of those with epithelial tumor was better than that with nonepithelial tumor.
    5. The classification for the tumor of the maxillary sinus proposed by Sakai was used in this study. The five-year survival rate of Stage II (63.9%) was distinctly better than those of Stage III (29.5%) and Stage IV (6.1%).
    6. The five-year survival rate for the maxillary tumor treated by irradiation and surgery was 42.2%. On the other hand, the ratio for the maxillary tumor treated by intraarterial infusion of anti-neoplastic agents with irradiation and antrostomy was 22.7%.
    7. The authors proposed a regimen of therapy for the maxillary cancer with intra-arterial infusion of anti-neoplastic agents and irradiation followed by radical surgery. The two-year experience of this regimen is encouraging.
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  • An Autopsy Study on the Malignant Tumors of the Maxillary Sinus
    Teruhiko Harada, Yasuo Sakakura, Mikikazu Yamagiwa, Fumi Hamaguchi, Ya ...
    1981 Volume 74 Issue 5special Pages 972-979
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_972
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    Statistical observation was made on autopsy cases of the malignant tumors of the maxillary sinus. Special attention was paid to the problems of the metastasis and intracranial invasion of the tumors. The autopsy study was conducted on 22 (59.5%) of the 37 patients who died at the Mie University Hospital between 1953 and 1980.
    Metastases to lymph nodes were found in 50.0% of the 22 cases; 36.4% in the regional lymph nodes and 31.8% in the distant nodes. Metastases to internal organs were found in 59.1% of the cases; 27.3% in the lung, 27.3% in the liver and 18.2% in the kidney. The rates of both nodal and distant metastases were higher in the case of non-epithelial tumor than those of epithelial tumor.
    Involvement of the base of the skull was found in 8 cases (36.4%) of the squamous cell carcinoma. The routes of tumor invasion to the base of the skull were studied on operation and autopsy. The anterior and middle fossae were the sites affected most frequently by the invasion.
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  • A Clinical Study of Malignant Tumor of Epipharynx
    A 20-year survey
    Sumiko Murai, Yasuro Miyoshi, Yasuo Sakakura, Kotaro Ukai, Mikikazu Ya ...
    1981 Volume 74 Issue 5special Pages 980-991
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_980
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    This report is based on the experience of 65 consecutive patients with malignant tumor of the epipharynx seen in the Department of Otolaryngology, Mie University Hospital during the 20 years between 1961-1980.
    The male to female ratio was 2.4:1. Carcinoma was predominant in the 6th decade, whereas malignant lymphoma was predominant in the 2nd and 6th decades of life. Of the 65 cases, 47 (72.3%) were cancer and 17 (26.3%) were malignant lymphoma. The three most common cancer were squamous cell carcinoma (17), transitional cell carcinoma (14) and lymphoepithelioma (12). The majority of the cases have been treated by radiotherapy. The crude 3-year and 5-year survival rates were 53.7% and 45.7%, respectively. The survival rate of cancer was 52.9% and that of malignant lymphoma was 25.0%. Of 34 patients with cancer, the rate was 33.3% for squamous cell carcinoma, 71.4% for transitional cell carcinoma and 63.0% for lymphoepithelioma. The size of local tumor affected survival, but in this study the cervical lymph metastasis did not.
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  • A Clinical Examination of Malignant Tumor of the Palatine Tonsil
    A 20-year survey
    Hiroyuki Nishioka, Yasuro Miyoshi, Yasuo Sakakura, Hiroshi Mitsui, Kei ...
    1981 Volume 74 Issue 5special Pages 992-1002
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_992
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    From 1961 to 1980, 45 patients with malignant tumor of the palatine tonsil were treated at the Department of Otolaryngology, Mie University Hospital. Of these, 12 patients were cancer and 33 sarcoma.
    Tonsillar cancer predominantly affected the male, whereas sarcoma was found in the male and female almost equally. The age distribution of tonsillar cancer was uniform, while there were two peaks in the fourth and seventh decades of life for tonsillar sarcoma. Eighty-three percent of cancer was squamous cell carcinoma, and all the sarcoma cases were malignant lymphoma of which 94% were reticulum cell sarcoma. Seventy-five percent of carcinoma were stage III or IV, while 94% of malignant lymphoma were stage I or II at the time of diagnosis. Sore throat was the most commonly encountered chief complaint for both carcinoma and malignant lymphoma. Three patients (25%) of those with carcinoma and four (12%) malignant lymphoma patients complained of a lump in the neck.
    All the patients with tonsillar malignancy underwent radiation therapy, and chemotherapy was also used in nine patients (75%) with carcinoma and 19 (58%) with malignant lymphoma. Crude survival rates for tonsillar cancer was 64% for 1 year, 20% for 2 years, 11% for 3 years and 0% for 5 years, and for malignant lymphoma of the palatine tonsil it was 45% for 1 year, 40% for 2 years, 37% for 3 years and 22% for 5 years.
    Although both carcinoma and malignant lymphoma had poor prognosis in this study, the preliminary results of combined radiation and chemotherapy for malignant lymphoma were encouraging. It was found that the total radiation dose of 5, 000-7, 000rads for carcinoma and 4, 000-6, 000rads for malignant lymphoma of the palatine tonsil was satisfactory in this study.
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  • Clinical Observation of the Malignant Tumors of the Larynx
    A 20-year survey
    Seiji Yamada, Yasuo Sakakura, Kotaro Ukai, Mikikazu Yamagiwa, Masuichi ...
    1981 Volume 74 Issue 5special Pages 1003-1011
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1003
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    A clinical study was conducted on a consecutive series of 223 malignant tumors of the larynx treated at the Department of Otolaryngology, Mie University Hospital during the 20 years from 1961 to 1980.
    The results obtained were as follows.
    1. There were 207 males and 16 females with a ratio of 12.9:1.
    2. Eighty-eight percent of the tumors occurred in the 5th, 6th and 7th decades of life.
    3. Hoarseness was the most frequent complaint in patients with glottic lesions. On the other hand, sore throat aggravated on swallowing was a characteristic complaint in patients with supraglottic lesions.
    4. Squamous cell carcinoma was the most common malignant tumor constituting 95.5% of all the cases, whereas there were only two cases of sarcoma.
    5. According to the TNM classification of malignant tumors proposed by the UICC (1978), there were 82 tumors (36%) of supraglottic origin, 122 (54.7%) of glottic, 9 (4.0%) of subglottic and 10 (4.5%) massive tumors without a distinguishable site of origin. Of these, 83 (37.6%) were classified as Stage I, 52 (23.5%) as Stage II, 61 (27.6%) as Stage III and 25 (23.5%) as Stage IV.
    6. The crude 5-year survival rate of 221 cases of carcinoma was 70.3%. Carcinomas which originated in the supraglottic region were more lethal than those which had originated in the glottic or subglottic region.
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  • Analysis of Deaths from Laryngeal Cancer
    A 20-year survey
    Masahiko Kubo, Yasuo Sakakura, Kotaro Ukai, Mikikazu Yamagiwa, Yoko Su ...
    1981 Volume 74 Issue 5special Pages 1012-1024
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1012
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    The authors reviewed 26 patients with laryngeal cancer who were treated in our clinic and died of the disease within 5 years after initial treatment in the period from 1961 to 1980 and analysed their therapeutic problems.
    Of the 26, 16 were classified as the supraglottic type, 5 as the glottic, 1 as the subglottic and 4 as the transglottic. The male to female ratio was 7.7:1. In 13 cases (50%), the initial treatment was thought to be carried out radically. Local recurrence after irradiation was controlled to a certain extent by total laryngectomy and metastasis to the cervical node after total laryngectomy was also treated by neck dissection. The average interval from initial treatment to death was 16.7 months.
    The main causes of poor results were thought to be the following:
    1) The lesion was more extended than was realized, 2) radiatian was unsuccessful in patients whose disease may have been curable by surgical treatment, 3) insufficient surgical field for the larynx and/or neck, 4) tumors were too advanced, 5) aged patients for whom radical treatment was not indicated, 6) patient's refusal of surgical treatment.
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  • A Clinical Study of Oral Cancer
    A 20-year survey
    Midori Hori, Yasuro Miyoshi, Yasuo Sakakura, Kotaro Ukai, Mikikazu Yam ...
    1981 Volume 74 Issue 5special Pages 1025-1037
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1025
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    One hundred and fortynine patients with carcinoma of the oral cavity were treated at the Department of Otolaryngology, Mie University Hospital from 1961 to 1980. There were 80 cases of tongue cancer, 19 of cancer of the buccal mucosa, 9 of cancer of the gingiva, 7 of cancer of the lips. The average age of these patients was 57.4 years old; ninety-four (63%) were male and 55 (37%) were female. According to the T classification proposed by the UICC, 43 (28.9%) were classified as T1, 66 (44.3%) as T2, 31 (20.8%) as T3, and 6 (4.0%) as T4. Although there were no cases of distant metastasis, cervical lymphnodal metastasis was found in 45 (30%). Of all the patients, the 1-, 3- and 5-year survival rates were 81.6%, 64.5% and 48.9%, respectively.
    In the analyses of the cases of tongue cancer, the following results were obtained: as the principal method of treatment of the tongue cancer, surgery and/or irradiation were employed. Especially, in the last 10 years, irradiation was preferred as the initial treatment of this cancer. The 5-year survival rate of tongue cancer was 66.7% in T1, 61.9% in T2 and 10.0% in T3. In the present study, we recommended radiation therapy for early cases of tongue cancer and combined therapy of irradiation and surgery for advanced cases.
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  • Thyroglossal Cysts During the Last 20 years
    Takashi Matsubara, Yasuro Miyoshi, Yasuo Sakakura, Yuichi Majima, Mido ...
    1981 Volume 74 Issue 5special Pages 1038-1043
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1038
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    This report is based on experience with 47 cases of thyroglossal cysts surgically treated in the Department of Otolaryngology, Mie University Hospital during the last 20 years from 1961 to 1980.
    Forty-two cases were of cysts and five were accompanied with fistula. These cases were comprised of 25 males and 22 females with a male-female ratio of 1.1:1.0. Thirty-three cases (69%) underwent operative treatment at the age of 30 years or younger. All of the cysts were located around the hyoid bone. Forty cases underwent the initial treatment in this department. The cyst and fibrous core of the tissue were removed with a midportion of the hyoid bone in 27.5% of these patients. None of these patients had recurrence. The cyst and core were removed with preservation of the hyoid bone in 72.5% of these patients and one of them had recurrence.
    Six of the seven patients who had had previous surgery were found to have had preservation of the hyoid bone. In the secondary surgery for two of these six patients, the cyst and core were removed with a midportion of the hyoid bone. The results were satisfactory.
    These results suggest that the midportion of the hyoid bone should be excised, if there is any difficulty in excising a core of the tissue extending to the base of the tongue under the hyoid bone.
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  • Tumors of the Major Salivary Glands
    Shuichi Nozaki, [in Japanese], [in Japanese], [in Japanese], [in Japan ...
    1981 Volume 74 Issue 5special Pages 1044-1053
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1044
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    One-hundred and eight cases of major salivary gland tumors and allied conditions treated in the Department of Otolaryngology, Mie University Hospital were reviewed according to the classification of the World Health Organization (WHO) and analyzed in terms of mode of presentation, diagnostic technique, treatment and end results.
    It was shown that the commonly involved salivary gland was the parotid gland and the most prevalent tumor was pleomorphic adenoma. Of the 108 cases, 81 were parotid tumor cases, and the ratio of benign to malignant tumors was 2.37:1. The remaining cases were tumors of submandibular and sublingual gland origin, and the ratio of benign to malignant was 1.71:1.
    We have principally performed enucleation surgery for all the benign parotid tumors, except six cases in which either superficial lobectomy or total lobectomy was performed. For malignant parotid tumors, enucleation surgery was performed in 9 cases, superficial lobectomy in two cases and total lobectomy in 10 cases. Of the above 21 cases, irradiation was added in 4 cases, combination therapy of irradiation and chemotherapy was administered in 11 cases. For all the cases of the tumor of the submandibular gland or sublingual gland, total extirpation of the gland with the tumor was performed.
    In accordance with the proposal of the American Joint Committee for Cancer Staging and End Results Reporting (1975), staging of 17 cases with malignant parotid tumors, which were followed more than one year, was determined. The five-year survival rate according to the stage was found to be 100% for T1N0M0, 75% for T2N0M0, 0% for T3N0M0, 0% for T3N1M0 and 0% for T3N1M1.
    The literature on new diagnostic procedures, treatment and prognosis was reviewed.
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  • Clinical Observation of 95 Patients with Malignant Lymphoma
    Yukiyoshi Hamaguchi, Yasuro Miyoshi, Yasuo Sakakura, Kotaro Ukai, Miki ...
    1981 Volume 74 Issue 5special Pages 1054-1063
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1054
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    Statistical observation of 95 patients with malignant lymphoma of the head and neck region treated for over 20 years (1961-1980) has been made.
    Statistical details were as follows.
    1) They included 59 males and 36 females with a male to female ratio of 1.6. Age distribution was such that the highest incidence was in the 6th decade.
    2) Twenty-nine percent of all the cases had painless swelling of cervical lymphnodes, which was the most frequent clinical sign, but most of the patients with malignant lymphoma of palatine tonsils and extra-lymphatic organs were characterised by local symptoms.
    3) Waldeyer's ring involvement in which the tonsil was the most popular site was seen in 65 (68%) of the 95 patients. Involvement of the nose and paranasal sinuses was not uncommon (9.5%).
    4) Stage II with lymphatic organ involvement was the most frequent (52%), in contrast to diffuse distribution to extra-lymphatic organs.
    5) In the histopathological distribution, almost all the cases were non-Hodgkin's lymphomata (97%), of which 81 were reticulum cell sarcoma and 10, lymphosarcoma.
    6) Most of the patients were treated by telecobalt or Lineac irradiated on the primary site regardless of the clinical stage. Although combined chemotherapy including MOPP, VEMP, CVP and VP was introduced from 1971 onwards, there was no criteria for indication of these modes of therapy.
    7) The 5-year survival rate was 47.1% for stage I, 25% for II, 28.6% for III, 0% for IV. It was higher in lymphatic organs than in extra-lymphatic organs. There was no difference in prognosis between the treatment with or without chemotherapy.
    These results indicate that lymphography, Ga scintigraphy and X-ray examination must be performed routinely before treatment in order to determine the clinical stage correctly. Regional irradiation is effective for the loco-regional stage but not effective for stage II with diffuse spreading.
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  • PPD Skin Reaction in Otolaryngologic Patients
    Hiroshi Mitsui, Yasuo Sakakura, Masashi Inagaki, Izumi Kanamaru, Masah ...
    1981 Volume 74 Issue 5special Pages 1064-1071
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1064
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    Immunological reactivity by means of the PPD skin reaction were studied in 1, 235 patients, who were admitted to the Department of Otolaryngology, Mie University Hospital, from 1976 to 1980.
    The overall rate of positive reaction was 42.1%. The rate was significantly different between males and females. Of the 980 patients with benign disease the rate was 40.5%, while of the 225 patients with malignant tumor the rate was 48.2%. In patients with malignant tumor, response to the PPD was positive in 53.3% at stage I, 68.2% at stage II, 41.3% at stage III and 42.6% at stage IV. There was a statistically significant difference in the rate of positive skin reaction among stage I, II and III, IV. The patients with positive skin reaction to the PPD at the time of admission were found to have a more favourable prognosis in comparison with those who were negative to the PPD.
    These findings suggest that the skin test reactivity to the PPD may be of use in patient management as one of the parameters of the host immune response.
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  • Otolaryngological School Screening Examination
    An eight-year survey
    Yukiyoshi Hamaguchi, Yasuro Miyoshi, Yasuo Sakakura, Kotaro Ukai, Miki ...
    1981 Volume 74 Issue 5special Pages 1072-1080
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1072
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    Otolaryngological school screening examination was carried out on 44, 932 students, 7 to 20 years of age, for eight consecutive years since 1973. They were examined by means of rhinoscopy by ENT specialists and 13 diseases were diagnosed. The results which were expressed in terms of prevalence rates were as follows:
    1: The prevalence rate of otitis media was 0-0.5% and remained unchanged for eight years.
    2: The rate of rhinitis was found to be 14.4%, the highest rate being in the 7-year-old children and the incidence decreased gradually with age to 3.0%, the lowest rate being in the 18-year-old students. The rate decreased gradually over the eight years. The prevalence rate of nasal allergy has increased remarkably in the eight years. The highest rate was 4.2% in the 15-year-old children. The rate of chronic sinusits has decreased slightly in the eight years. The highest rate was 5.0% in the 9-year-old children. However, no significant difference for the prevalence rate was found among the age groups for both chronic sinusitis and nasal allergy.
    3: The prevalence rate of palatine tonsillar hypertrophy was 18.9%, the highest rate being in the 7-year-old children and the incidence decreased with age to 2.0%, the lowest rate being in the 19-year-old students. The rate increased gradually over the eight years. The prevalence rates of chronic tonsillitis were highest in the 9 and 20-year-old groups being 12.1% and 12.5%, respectively. The lowest rate was in the 15-year-old children at 5.7%. The rate decreased in the eight years.
    Although the results were influenced by the individuality of the examiners and there were certain limitations of the examination which depended only on rhinoscopy, a general impression that infectious disease has decreased and allergic disorder has increased in the nose was confirmed in this study. Discussion on the general significance of school screening examination was also reported, including a system of otolaryngological school screening examination and the diseases to be screened for.
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  • A Study of Postoperative Healing Process of Chronic Sinusitis
    Taro Maeda
    1981 Volume 74 Issue 5special Pages 1081-1109
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1081
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    Chronic sinusitis is one of the most prevalent nasal disease in Japan. Conservative or surgical treatment has long been accepted as effective treatment for chronic sinusitis, but conservative treatment is of little value in some of these cases. Even surgical treatment is not always satisfactory.
    To practise the pathogenesis of chronic sinusitis, the present study was attempted to identify the relation between preoperative mucosal findings in maxillary sinus and postoperative healing process of chronic sinusitis. Clinical histopathological examination of the healing process in maxillary sinus was performed in 133 patients with chronic sinusitis from one week to six months postoperatively.
    After surgical treatment we had good prognosis for headache and nasal discharge, but bad for postnasal dropping. Subjectively their complaint was improved except 23% of patients who underwent operation. During 3 or 6 months recurrent sinusitis was found 60% of operated patients who discharged, but 18% over one year. Many cases of good intranasal findings after operation were macroscopically fibrotic type in both maxillary and ethmoidal sinus, the second edematous type, and the third polypous type. Also, those which retained secretion showed good intranasal finding. On the other hand, in the cases of polypous type with pus retension in maxillary sinus and edematous type with pus retention in ethomoidal sinus, intranasal findings after operation were poor. Though there were not significant difference between prognosis and histopathological changes of mucosa in maxillary sinus before operation, in ethomoidal sinus edematous type macroscopically showed unfavourable prognosis. While, there were clear correlation between histological changes of mucosal regeneration and intranasal finding postoperatively.
    Those results suggested that postoperative healing process was intimately related to histopathological changes of mucosa in both maxillary and ethomoidal sinus before operation. When aftertreatment is based on a clear understanding of the postoperative process and the effects of the various operative methods on the healing process, we considered that the best results might be got.
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  • A Study on Speech Signals Picked up at the Head
    Acoustic Analysis and Clinical Applications
    Chieko Taniguchi
    1981 Volume 74 Issue 5special Pages 1110-1125
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1110
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    Bone-conducted vowels and consonants were picked up by a vibration transducer of the acceleration type applied to the upper jaw. They were analysed acoustically with respect to the volume level of vibration on the maxilla, wave forms and spectral envelope.
    Fifty-six subjects included 19 with insufficient closure of the nasopharynx, 21 with maxillary lesions and 19 patients who received various kinds of maxillofacial surgery.
    The results are summarized as follows. In those with insufficiency of nasopharyngeal closure, it was found that 1) the volume level of vibration depended on the condition of the palate; 2) the energy used to produce the phonation of the vowels/e/ and /i/ was transmitted through the hard palate; 3) regarding the wave form, the emphasis on the component of nasal consonants was clearly recognized in abnormal patients, but not in those with omission. Thus, the volume level of vibration and the emphasis on the component of nasal consonants could be used as one of the objective parameters of clinical evaluation of the repair of the cleft palate with articulation disorder.
    In patients with abnormal maxilla, it was shown that 1) the volume level of vibration was strongly dependent on the size of the defect of the maxillary bone, but not on the contents of the antrum or location of its defect. 2) spectral analysis revealed that the peak wave (2, 500Hz) during the phonation of /e/ and /i/ was influenced by the location of the defect of the maxilla and the contents of the antrum. 3) The emphasis on the components of nasal consonants was not dependent on the abnormality of the maxilla. It is suggested that acoustic analysis of speech signals picked up at the surface of the head and neck is useful as one of the diagnostic parameters of the maxillopalatal disorders.
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  • A Scanning Microscopic Study on the Effects of Radiation on the Laryngeal Mucosa of Human and Rat
    Tsuyoshi Taniguchi
    1981 Volume 74 Issue 5special Pages 1126-1145
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1126
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    The fine surface structure of the laryngeal mucosa of humans and rats was investigated by using a scanning electron microscope and an X-ray microanalyser.
    Experimental materials were obtained from human patients who were treated with doses of 3000r to 4000r for laryngeal cancer and rats which had been raised on a normal diet or a diet deprived of vitamin E. These rats were experimentally irradiated with doses of 1000r to 1500r.
    Significant changes on the laryngeal surface of the humans were seen on the supraglottic areas and ventricular cavity which were composed of nonciliated cells. There was loss of nonciliated cells from the surface and tightly packed microvilli on the surface. In some areas of the ciliated laryngeal epithelium, there were compound cilia, blebformation, polyp-like formation of cilia, and/or shortened cilia.
    The surface structure of the larynges of the rats experimentally irradiated rat with doses of 1000r to 1500r showed similar findings to those of the humans. They were especially prominent in the vitamin E-defficient rats.
    The surface structure of laryngeal cancer treated with radiation showed a bulging formation of cells, an irregular surface of intercellular space.
    In the biochemical study using an X-ray microanalyser, phosphorus and sulfur were found more frequently on the laryngeal cancer than on the intact larynx.
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  • Immunological Aspects of Chronic Sinusitis
    Yasuo Sakakura, Kotaro Ukai, Yuichi Majima, Seiichiro Yoshii, Masuichi ...
    1981 Volume 74 Issue 5special Pages 1146-1158
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1146
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    Chronic sinusitis is one of the most prevalent nasal illnesses, especially in Japan. The pathogenesis of this disease has not yet been fully understood. Nasal and maxillary secretions may reflect pathological environments in the nose and paranasal sinuses. Therefore, analysis of immunoglobulins in these secretions may lead to better understanding of the pathogenesis and facilitate evaluation of the severity and effectiveness of the therapy of this disease. We measured concentrations of IgA, 11S IgA, IgG, IgM, total secretory component (SC) and albumin in the nasal and maxillary secretions from patients with chronic sinusitis.
    The immunoglobulin levels and the 11S IgA to IgA ratios of the subjects showed large variability. The immunoglobulin to albumin ratios indicated that a bulk of IgG in the secretion was derived from the serum. There were significant differences of the mean concentrations of IgA and IgM between nasal and maxillary secretions. The percentage of SC-positive (more than 0.5mg/dl) secretion was significantly higher in the nasal than the maxillary secretion. An immunofluorescent study of the surgically removed nasal and maxillary mucosa revealed that immunoglobulin-containing cells tended to be more numerous in the nasal than the maxillary mucosa. A tendency of IgA-containing cells to form aggregation in the superficial layer of the subepithelium and around the gland was characteristic of the maxillary mucosa, while in the nasal mucosa these cells tended to concentrate around the glands. These facts suggested that there was an immunological dissociation between the nasal and maxillary mucosae. In 31% of maxillary secretions, concentration of SC was less than 0.5mg/dl and this was found to be constant after repeated maxillary aspirations. The IgA to IgG concentration ratio which was less than 1.0 at the first aspiration exceeded 1.0 and the correlation between IgA and SC concentrations became significant after repeated maxillary aspirations.
    Although there was little direct evidence implicating immunological processes in the pathogenesis of chronic sinusitis, the circumstantial evidence found in this study suggested that there was an accumulation of immunoglobulins in the maxillary environment and the IgG antibody might mediate an adverse effect.
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  • A Longitudinal Study of Proteins in Maxillary Sinus Secretion from Chronic Sinusitis Patients
    Masuichi Ohi, Yasuo Sakakura, Yuichi Majima, Hiroshi Mitsui, Yukiyoshi ...
    1981 Volume 74 Issue 5special Pages 1159-1169
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1159
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    Maxillary sinusitis, like nasal allergy, is one of the most prevalent nasal illnesses in Japan. The pathogenesis of this disease, however, has not yet been understood fully. This study was undertaken to analyze the local immunity of the antral environment in patients with chronic sinusitis, to evaluate whether this immunological environment might have any implication for the course of this disease and to determine whether lavage or aspiration of sinus secretion could be a useful treatment for this disease. The antral environment was studied by means of 142 specimens of maxillary sinus secretions obtained from 138 patients with this disease.
    The mean concentration ratio of IgA/IgG in these secretions was less than 1.0 at the first aspiration, but this ratio came to exceed 1.0 after repeated aspirations. This indicated that there was a bulk of IgG in the maxillary environment of this disease and this IgG derived from circulation could mediate an adverse effect on the mucous membrane. During the course of aspiration therapy, IgA and IgM increased while IgG decreased in the maxillary secretion. In the 30-40% of the sinus secretions, the concentration of secretory components was found to be always less than 0.5mg/dl despite repeated aspirations. These patients should be clearly distinguished from those in whom the concentration of secretory components is always more than 0.5mg/dl. In the latter group, the correlation of the concentrations between IgA and the secretory component had become significant by means of the repeated aspirations.
    Aspiration of maxillary sinus secretion in patients with chronic sinusitis was concluded to be useful for improving the immunologically pathologic environment of the maxillary sinus mucosa.
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  • Kinetics of Immunoglobulins in Nasal Secretions of Chronic Sinusitis and Nasal Allergy
    Yukiyoshi Hamaguchi, Yasuo Sakakura, Yuichi Majima, Masuichi Ohi, Hiro ...
    1981 Volume 74 Issue 5special Pages 1170-1181
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1170
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    Chronic sinusitis is still one of the most prevalent nasal illnesses in Japan. The pathogenesis of this disease has not been fully understood yet. It has been shown that most of the IgA antibody secreted from the normal respiratory mucosa appeared to be of 11 S-IgA type. However, when the condition is inflammatory, change in the normal epithelial-capillary barrier results in a marked influx of serum immunoglobulins and other proteins, so that the kinetics of immunoglobulin classes in the external secretions changes remarkably and becomes more complicated.
    In the present study, we measured the concentration of immunoglobulins and other proteins in the nasal secretions from chronic sinusitis and nasal allergy, which represent the chronic nasal diseases of infectious and allergic inflammation, respectively. In the nasal allergy, the mean concentration of immunoglobulins was very similar to that of the previously-reported normal subjects. The mean concentrations of IgA, IgG, IgM and S-IgA in chronic sinusitis were significantly different from those in nasal allergy and the mean concentration of S-IgA in chronic sinusitis was almost three times as high as in nasal allergy. Comparing the concentration ratios of IgA/IgG and IgA/albumin with the normal in the serum, it was found that there was high local production of IgA in both diseases. However, the mean concentration of S-IgA and mean concentration ratio of S-IgA/total IgA in purulent secretion were not significantly different from the mucous secretion of chronic sinusitis and they varied considerably. In one-third of purulent secretions, the S-IgA/total IgA ratios were very low. α1-antitrypsin which is the main protease inhibitor in the serum had a significant correlation with the concentrations of DNA and IgG, but not with S-IgA. S-IgA was measured by the enzyme-linked immunosorbent assay and electroimmunodiffusion with the enzyme -labeled antibody method.
    In conclusion, it was found that there were different immunoglobulin kinetics in the noses of patients with chronic sinusitis and nasal allergy and immunoglobulin concentrations were different between purulent and mucous secretions of chronic sinusitis. Although the bulk of IgA and IgG was derived from serum, it was suggested that local synthesis of IgA and IgG was active in the nasal mucosa of chronic sinusitis.
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  • Defense Mechanism against Newcastle Disease Virus in Chicken Maxillary Sinus
    Shuichi Nozaki, Kotaro Ukai, Yasuo Sakakura, Takashi Masubara, Yasuro ...
    1981 Volume 74 Issue 5special Pages 1182-1190
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1182
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    The mechanism of resistance to the mesogenic Newcastle disease virus in the chicken maxillary sinus and turbinate was studied by intranasal inoculation.
    The lesions induced by the intranasally inoculated NDV-B were usually selective destruction of significant portions of the inner surface of the turbinate scroll, but sinus lesions though sometimes present in NDV infection were not common. These results were supported by the amount of the virus and the mucociliary transport time in the turbinate and sinus.
    The chicken maxillary sinus was infected with NDV-B by intrasinus inoculation. Although cessation of the mucociliary function was not observed after the application of 5% cocaine into the maxillary sinus, deceleration of the sinus clearance time after treatment was statistically significant. The virus was recovered from the chicken maxillary sinuses which were treated with 5% cocaine after 24 hours of intranasal NDV infection, and this is supported by histologic examination.
    From these results, it has been shown that the mucociliary activity in the maxillary sinus, especially in the sinus ostium, rather than the direction of the mucociliary flow, is one of the most important factors of protection against sinus infection.
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  • Mechanism of Slowing of Nasal Mucociliary Transport Induced by SO2 in Chicken
    Yuichi Majima, David L. Swift, Betsy G. Bang, Frederik B. Bang
    1981 Volume 74 Issue 5special Pages 1191-1203
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1191
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    Slowing of mucociliary transport following exposure to SO2 is a well established phenomenon in a variety of animal models and in humans. In chickens, exposure to 6ppm SO2 decreased the mucociliary transport rate (MTR). Intramuscular pilocarpine injection recovered the slowing of MTR induced by SO2 but did not change the MTR in control animals. This suggests the slowing of MTR induced by SO2 is not due to either destruction of cilia nor disturbance of ciliary movement per se, but to alternations of properties or conditions of the mucus layer. The minimum force required to move an iron particle on the mucus by magnetic field in vivo (Fviv) increased significantly after exposure of the chickens to SO2, while the minimum force in vitro (Fvit) showed no change after the exposure. The in vivo recoil distance decreased significantly after SO2 exposure in comparison with control values. There was no significant difference in the in vitro recoil distance of the mucus between the SO2-exposed and control groups. The pattern of both Fviv and in vivo recoil distance are similar to that of the MTR during the 7 days of SO2 exposure. These results suggest the existence of in vivo factors, such as the tethering phenomenon or decreased thickness of sol layer, in the mucous layer during SO2 exposure, which may decrease the MTR.
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  • Effect of SO2 on Nasal Secretory Cells in Chicken
    Yuichi Majima, Harue Okuyama, Betsy G. Bang
    1981 Volume 74 Issue 5special Pages 1204-1214
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1204
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    Acini and goblet cells of the terminal one-third of the chicken maxillary choncha during exposure to moderate levels of SO2 over time were studied histochemically. Numbers of luminal acinal cells containing intracellular glycoproteins were sharply reduced on the 1st, 7th and 14th days of 11.8ppm SO2 exposure, while goblet cell numbers were markedly increased during the exposure. Modifications of types of the intracellular glycoprotein were not observed in acinar cells. The increased goblet cells contained neutral glycoprotein predominantly on the 1st and 5th days of the exposure and then contained acid glycoprotein on the 7th and 14th days of the exposure. The modification of the intracellular glycoproteins had taken place in goblet cells within 2 days during the 5th and 7th day of the exposure.
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  • Nose of Bronchial Asthma and Allergic Rhinitis in Pediatric Patients
    Kotaro Ukai, Yasuo Sakakura, Yukiko Itoh, [in Japanese], Yasuro Miyosh ...
    1981 Volume 74 Issue 5special Pages 1215-1222
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1215
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    This study was undertaken to ascertain whether nasal laboratory findings in asthmatic patients without nasal symptoms could be different from those in nasal allergic patients.
    Sixty-five patients between the ages of 5 and 18 years with extrinsic asthma (asthma group) were investigated by nasal symptoms, signs, and other laboratory findings. These results were compared with those obtained in the 71 patients of nasal allergy to house dust (nasal allergy group).
    1. The mean value of FEV1 in the asthma group was 67.9%±22.0.
    2. The skin test reaction to house dust was positive in 90.8% of the asthma group.
    3. The nasal provocative test to house dust was positive in 67.7% of the asthma group.
    4. Eosinophils in nasal secretions were abnormally increased in 44.6% of the asthma group.
    5. In the asthma group, 30.8% had asthma alone, 9.2% had asthma with atopic dermatitis, 40% had asthma with allergic rhinitis, and 20% had asthma with atopic dermatitis and allergic rhinitis.
    6. Maxillary sinusitis was found in 40% of the asthma group by nasal X-ray examination.
    7. Neutrophils in nasal secretion were increased abnormally in 53.1% of the asthma group.
    8. The mean value of eosinophils in the blood was 800.8/mm3±559.4 (n=62) in the asthma group, and 616/mm3±400 (n=66) in the nasal allergy group. There was a statistically significant difference between both groups (P<0.001).
    9. The mean values of serum IgE were 2474.8IU/ml±2640 (n=61) in the asthma group and 569.6IU/ml±670.5 (n=66) in the nasal allergy group. There was a statistically significant difference between both groups (P<0.001).
    10. The dilution test of the skin reaction and the RAST SCORE showed similar patterns in both groups.
    11. There was a similar correlation in the nasal signs of both groups. On the other hand, there was a converse correlation in the nasal symptoms of both groups.
    12. It was supposed that the difference in nasal symptoms in both groups might come from the difference of nasal mucosal reactivity or a concentration of histamine released from basophilic cells.
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  • A Study of Reflectance Spectrum of Nasal Mucosal Pathology
    Shigeru Furuta
    1981 Volume 74 Issue 5special Pages 1223-1230
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1223
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    An analysis of the color and pathological situation of nasal mucosa was made on 18 normal adults, 24 nasal allergic patients and 9 patients with total laryngectomy using a new piece of equipment, a spectrophotometer that was specially designed by the author. The results obtained were as follows.
    1) By analyzing the reflectance spectra of Munsell's color Standards, it was successfully demonstrated that the color difference could be determined by this method.
    2) The reflectance spectra of nasal mucosa were characterized by the peak of absorbance in the visible region (400-800mμ) and the mean value of that in normal adults was 663.8±5.4mμ.
    3) The peak values of the reflectance spectra in the patients with nasal allergy composed of different grades of symptoms and different kinds of antigens showed a broader range than normal.
    4) The peak values of the laryngectomized patients who had been alive for four years postoperatively tended to concentrate around a certain value, such as 640mμ.
    From the above-mentioned results, the clinical significance and further application on the mucosal pathology in the otolaryngological field were discussed briefly.
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  • Secretory IgA in Human Palatine Tonsils
    Hiroshi Mitsui, Yasuro Miyoshi, Yasuo Sakakura, Shuichi Nozaki, Hiroyu ...
    1981 Volume 74 Issue 5special Pages 1231-1240
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1231
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    A considerable number of investigations on the local immune defense mechanism have shown that the secretory component (SC) may not be synthesized in the palatine tonsil in humans. To investigate the local immune system, especially the secretory IgA system in human palatine tonsils, the present study was designed to identify the distribution of IgG-, IgA-, IgM- and IgE-containing cells and 10S IgA-containing cells which could be distinguished by the intracytoplasmic SC-affinity test and the existence of secretory component. By immunoelectrophoretic and gel diffusion studies, quantitative determination of secretory IgA in the tonsil was made.
    Immunoglobulin-containing cells were found in 4 compartments of the tonsils, most of which were located in the extrafollicular areas; IgM containing cells were frequently present in the germinal center. The tonsillar immunocytes population showed an overall IgG:IgA:IgM:IgE class ratio of 58.1:34.0:5.8:2.1. The tonsil was not stained for SC. However, the glandular lumen and intercellular spaces of the Weber's glands were faintly stained for SC. 10S IgA-containing cells were detected in the crypt area of the tonsil and Weber's glands. Furthermore, 11S IgA was detected by immunoelectrophoresis and immunodiffusion in the tonsil extracts.
    Although the major local immune defense of the palatine tonsil may depend on the salivary fluid, we proposed a hypothetical model for the transport of 10S IgA and 10S IgA-containing cells across the crypt epithelium and for conjugation with the free secretory component (FSC) derived from saliva in the crypt lumen on the palatine tonsils.
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  • A Scanning Electromicroscopic and X-ray Microanalytical Study of the Respiratory Muco-ciliary System
    Shinpei Yamamoto, Masaru Ohyama, Tsuyoshi Taniguchi, Seiji Yamada
    1981 Volume 74 Issue 5special Pages 1241-1246
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1241
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    The tracheal mucosae of the mouse, rat, rabbit and human were studied with a scanning electromicroscope and an X-ray microanalyzer (EDX). Small amounts of calcium were detected on the cilia and ciliated area of the surface cell. Large amounts of sulfur and phosphorus were detected on the mucous layer and the hypersecreting cells. This was confirmed with ruthenium-traced speciments. Occasionally, silica was found on the muco-ciliary system and large amounts of phosphorus were found on the Clara cells of rats.
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  • Glottic Closure Reflex
    Mikikazu Yamagiwa, Yasuro Miyoshi, Yasuo Sakakura, Keizo Fukukita, Mas ...
    1981 Volume 74 Issue 5special Pages 1247-1261
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1247
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    Reflex responses elicited in the adductor branches of the recurrent laryngeal nerve (RLN) by electrical stimulation of various nerves were studied on anesthetized cats in order to elucidate the mechanism of glottic closure reflex. The following results were obtained in this experiment.
    1. A single pulse stimulation to each of the infraorbital branches of the trigeminal nerve (ION), facial nerve branches distal to the level of the stylomastoid foramen (VII), glossopharyngeal nerve (GPN), superior laryngeal nerve of the vagus nerve (SLN), hypoglossal nerve (XII) and great auricular nerve (GAN) elicited reflex responses in the RLNs bilaterally and that to the accessory nerve branches innervating the trapezius muscle elicited reflex responses in the ipsilateral RLN.
    2. The frequency-dependent attenuation of reflex responses in the right RLN elicited by repetitive stimulation of those nerves on the right side were also studied and it was found that repetitive stimulation of the SLN produced the least attenuation in RLN responses. On the other hand, the attenuation of RLN responses elicited by repetitive stimulation of the GAN occurred most easily.
    3. The RLN reflex responses evoked by test stimulation of the right SLN were influenced by conditioning stimulation of each of the ipsilateral ION, VII and GPN, but not by that of XII. Those were facilitative and/or inhibitory influences of conditioning stimulation upon the test reflex responses.
    These results indicate that the protective laryngeal closure reflex may be evoked by various types of sensory stimuli and be influenced by their subtle interactions.
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  • A New Modified Technique of Widening of the Anterior Glottis for Bilateral Recurrent Laryngeal Nerve Paralysis
    Masaru Ohyama, Makoto Yamamoto, Makoto Hashimoto, Shigeru Furuta, Taku ...
    1981 Volume 74 Issue 5special Pages 1262-1268
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1262
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    Two patients with midline fixation of the bilateral vocal cords were operated on by a new, modified technique of widening the anterior glottis. This method aims at closing the fistula using the tracheal or septal cartilagomucosal graft following widening of the anterior commissure of the glottis in one stage.
    The most important problem is deciding how wide the glottal aperture should be and choosing a graft from the trachea or nasal septum of an appropriate size. Postoperatively, the dyspneic condition of the patients was relieved successfully and their voices retained intelligible quality.
    Laryngoplastic surgery for dyspneic conditions and its functional results were discussed briefly.
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  • Cytodiagnosis of the Head and Neck Lesions
    Keizo Fukukita, Ryuichi Yatani, Yasuo Sakakura, Mikikazu Yamagiwa, Yas ...
    1981 Volume 74 Issue 5special Pages 1269-1275
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1269
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    In order to evaluate the advantage of the cytological diagnosis of tumors in the head and neck, the author examined one hundred and eight composed of fifty-eight benign lesions and fifty malignant lesions. Cytological diagnosis was found to correlate with histopathological diagnosis in 85.2% of the cases examined. The accuracy rate was 78% in malignant cases and 91.4% in benign cases. In aspiration smear, the accuracy rate was 91.7% and 90% in direct imprint of the surface of the lesions. It was confirmed that the cytological diagnostic method is clinically significant and useful for the diagnosis of tumors in the head and neck.
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  • Clinical Observation of Tonsillar Focal Infection
    Effect of Tonsillectomy on Secondary Infection and Evaluation of Provocation Test in Diagnosis
    Hiroshi Mitsui, Yasuro Miyoshi, Yasuo Sakakura, Yukiko Ito, Takashi Ma ...
    1981 Volume 74 Issue 5special Pages 1276-1284
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1276
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    With the increasing attention given to the immunological role of the tonsil, a conservative attitude has developed toward tonsillectomy. We know, however, that there are some diseases which respond to tonsillectomy. This idea has introduced the concept of tonsillar focal infection. Unnecessary onsillectomy must be avoided. Hence, it is critical to determine whether the tonsil is the primary focus of infection or not.
    Seventy-one patients were suspected of tonsillar focal infection by the tonsillar provocation test and tonsillectomy was indicated. Thirty-eight patients underwent tonsillectomy and 68.4% of them showed improvement in their secondary diseases. Thirty-three patients for whom tonsillectomy was indicated did not undergo the operation and 39% of them showed improvement in their secondary diseases. The difference in the rate of improvement between the two groups was statistically significant. Those who underwent tonsillectomy within one year from the onset of the secondary disease improved more than those who underwent the operation after three years from the onset. The improved secondary diseases included kidney, skin and rheumatic diseases.
    We have been employing a massage provocation test when tonsillar focal infection is suspected. The patients whose secondary disease was alleviated had an increased number of WBC by the provocation test compared to those whose secondary disease was not alleviated. Among the non-tonsillectomized patients, those whose with secondary disease was not alleviated increased the number of WBC by the provocation test compared with the patients who improved. Other variables, such as ESR, body temperature and urinalysis were not significantly changed by the provocation test. It has thus been indicated that the increase in the number of WBC by the provocation test is a useful indicator of tonsillectomy for tonsillar focal infection.
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  • Treatment of Exudative Otitis Media by Ear Instillation and Reverse Politzerisation
    Kouji Toyoda, Tomoo Kimura
    1981 Volume 74 Issue 5special Pages 1285-1290
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1285
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    As one of the local treatments of intractable cases of exudative otitis media, a method consisting of ear instillation and reverse politzerisation was proved to be effective.
    A total of 297 ears of 200 patients were encountered by the authors. Of them, 248 ears were treated by ear instillation and reverse politzerisation with various drugs at the same time with other local and systemic treatments. As a result, all the treatments were effective in 104 ears and a little effective in 137 ears. In other words, they displayed only a transitional effect and failed to bring about complete healing in about a half of the ears treated.
    The principle of the proposed method consists of draining and cleaning of the auditory tube and the tympanic cavity. It is supported by the antiphlogistic action of drugs. In this method it is better to use Brünings's anastigmatic otoscope, as well as the pneumatic otoscope, than Politzer's bag. Each otoscope has a rubber or resin ring at the pointed end. When it is attached closely to the external auditory foramen, it is almost always possible to carry out reverse politzerisation through an incised or punctured opening of the tympanic membrane.
    Of the drugs used, one which dissolves mucus did not exhibit such effect as anticipated. The best effect was displayed by epinephrine added to a solution of dexamethasone or betamethasone. To prevent any disturbance of the internal ear from occurring, it is necessary to avoid the use of any drug which is toxic for the auditory organ. Even in the case of the other drugs, attention must be paid to the kind, concentration, and dose of a given drug and changes induced by a combination with another drug. In addition, cases of tinnitus and dysacousis caused by an excessive dosage of epirenamin and vertigo induced by alcoholism were reported. Discussion was also made on measures to prevent the side effects of drugs from appearing.
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  • Thermosurgery for Habitual Tonsillitis
    Tomoro Kimura
    1981 Volume 74 Issue 5special Pages 1291-1303
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1291
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    The author applied thermosurgery to 30 patients with habitual tonsillitis who refused to receive tonsillectomy. This is a method to disorganize tonsillar tissue with heat by pricking the tonsils with the tip of a cautery heated up to 700°C. The cautery is applied to three spots, namely, the fossa superior, central part and lower pole of the tonsil. Cauterization of 15 to 20 seconds a time is sufficient. The burned tissue will fall off within about a week and lacunae are made open. The patients who received this kind of operation were followed up for three years. It was apparent that with one - or two-time cauterization such tonsillitis abated well with a result that was rated “markedly effective” in eight cases, “effective” in 14 cases and “fairly effective” in four cases, although four cases are still under observation. There were no “ineffective” cases whatsoever.
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  • A Case of Herpes Zoster Infection with Paralysis of the Vth, VIIth, VIIIth, IXth and Xth Cranial Nerves
    Yoko Sugiyama, Yasuo Sakakura, Mikikazu Yamagiwa, Teruhiko Harada, Yas ...
    1981 Volume 74 Issue 5special Pages 1304-1311
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1304
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    A case of a 59-year-old male with paralysis of the right Vth, VIIth, VIIIth, IXth and Xth cranial nerves is reported in this paper. The patient had complaints of ear and facial pain, peripheral facial palsy on the right side, right hearing impairment, vertigo and dysphagia. Herpetic vesicles were found in the cavum conchae and the area around the ear, eye and lips on the right side. On oral and pharyngolaryngeal examination the following pathological findings were revealed: paralysis of the soft palate on the right side, herpetic enanthema of the epiglottis, aryepiglottic fold and false cord on the right side with vocal cord palsy. On the examination of hearing and vestibular function, right sensorineural hearing loss and canal palsy were found. Lymphocytosis was shown on the cerebrospinal fluid examination. A significant rise in the antibody titer to herpes zoster virus and a moderate rise in those to herpes simplex and influenza A virus. These findings strongly indicated that herpes zoster infection affected the Vth, VIIth, VIIIth, IXth and Xth cranial nerves concurrently in this case. Six months after the first examination, disturbance of the Vth, VIIth and IXth cranial nerves abated completely and that of the Xth cranial nerve was alleviated to a certain extent by the administration of a massive amount of ATP. The disturbance of the VIIIth cranial nerve, however, did not respond to the treatment at all.
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  • A Case of Rhinogenic Intracranial Complication
    Seiichiro Yoshii, Keizo Fukukita, Hiroshi Fuke
    1981 Volume 74 Issue 5special Pages 1312-1320
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1312
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    Rhinogenic Intracranial infection is a rare complication. Intracranial complication arising from nasal infections, principally afflictions of the accessory sinuses, is a very grave complication. Since the advent of chemotherapy and various antibiotics, its incidence and morbidity has diminished appreciably.
    A case of rhinogenic spontaneous Intracranial complication is reported herein. The patient was a 16-year-old man with a swelling around the left eye-lid that had existed for two days. There had been headache and high fever. On examination, the spinal fluid was under pressure with a high cell count, consisting mostly of poly-morphonuclear cells. Four days after admission, he went into coma. Rhinogenic intracranial complication was suspected. A radical ethmoid, antrum and frontal sinus surgery was immediately carried out. Ten grams of SB-PC and 200mg of DKB were administered daily, but 12 days after admission, the careful CT scanning revealed that he had a subdural abscess. Drainage of the subdural abscess was carried out. The patient made a complete recovery 7 weeks after admission.
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  • Two Cases of Maxillary Sinus Cyst
    Tsutomu Matsuba, Kenzo Yagi
    1981 Volume 74 Issue 5special Pages 1321-1327
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1321
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    Genuine cysts of the paranasal sinus are commonly found in the frontal or ethmoidal sinus, but rarely in the maxillary sinus. They are apparently caused by the obstruction of the outlet of the sinus in the nose.
    Non-odontogenic cystic lesions of the maxillary sinus are highly suggestive of a malignant growth when there is evidence of bony destruction and enlargement of the maxillary sinus cavity on radiological examination. For differential diagnosis, computed tomography (CT) can be useful in addition to the conventional radiological examination.
    Two cases of non-odontogenic cyst of the maxillary sinus were examined by conventional radiology and CT scan. The first patient with a painless swelling in the left cheek was differentiated from a malignant tumor by the difference of density between the cyst wall and cyst fluids on CT scan. The second case complaining of left nasal obstruction was suspected of having malignancy in the left maxillary sinus on CT scan, because the cyst contents were filled with fibrin mass. The correct diagnosis was obtained from surgery and histopathological examination.
    In the cystic lesions of the paranasal sinus, CT scan is not very reliable for the detection of differences of density according to the nature of the cyst fluids.
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  • A Case of a Foreign Body in the Maxillary Sinus
    Sumiko Murai, Yasuo Sakakura, Kotaro Ukai, Yukiko Ito, Masashi Inagaki
    1981 Volume 74 Issue 5special Pages 1328-1332
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1328
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    The authors reported a case of a foreign body in the left maxillary sinus. An 8-year-old girl with swelling of the left cheek visited Mie University Hospital on December 19, 1979. Fifteen days earlier, the patient had received an accidental injury which was the puncture of the nasal vestibulum by a bit of dry grass on the playground. After removal of a small piece of dry grass, treatment was given with antibiotics for two weeks but her condition did not improve.
    Probe operation of the maxillary sinus with a labiogingival incision was carried out three days later. A stick of dry grass, which was 6cm in length and 8mm in diameter, was found in the maxillary sinus with a large defect in the upper part of the fossa canina. It was thought that the stick of dry grass was stuck in the anterior wall of the maxillary sinus, having entered from the nasal vestibulum through the buccal soft tissue. The shape of the grass was presumably that of a tall golden rod.
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  • A Case of a Maxillary Antrolith
    Kunio Shoji, Haruki Fukuo, Yasuo Sakakura, Yasuro Miyoshi
    1981 Volume 74 Issue 5special Pages 1333-1337
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1333
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    A case of a maxillary antrolith, a calcareous body found in the maxillary sinus cavity of a 38-year-old male was reported. The patient has a 3-year history of left epistaxis and headache. Three months prior to examination he developed dull pain on the left upper molar region. Although rhinoscopy revealed normal findings, a small radiopaque image was obtained at the bottom of the maxillary sinus by orthopantomography. The maxillary antrolith was removed through a gingivolabial approach. The removed antrolith was 10×9×4.5mm in size and weighed 0.3 grams. The case was compared with a case of a tooth in the maxillary sinus and maxillary osteoma in terms of radiology and surgical findings.
    We analyzed 21 such cases reported in the Japanese literature and discussed the differential diagnosis of maxillary antrolith.
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  • Two Cases of Adenoid Cystic Carcinoma Originated in the Tongue
    Kenzo Morikawa, Koh Kaneko, Sadao Tanaka, Takuo Nobori, Makoto Hashimo ...
    1981 Volume 74 Issue 5special Pages 1338-1344
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1338
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    Two cases of adenoid cystic carcinoma originated in the tongue treated by irradiation, chemotherapy and immunological therapy were reported. The first case, a 79-year-old woman who had complained of tongue pain was treated with the combined therapy of anti-tumor agent and immunopotentiator. The other case, a 48-year-old woman was treated by irradiation, chemotherapy and immunological therapy using the Nocardia rubra cell-wall skeleton. Both patients are still alive after about 4 years.
    The clinical signs, therapy and prognosis of this tumor were discussed briefly from the clinico-pathological viewpoint.
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  • A Case of a Pedunculated Cyst of the Palatine Tonsil
    Haruki Fukuo, Kunio Shoji, Yasuo Sakakura, Yasuro Miyoshi
    1981 Volume 74 Issue 5special Pages 1345-1348
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1345
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    This report concerns a case of a pedunculated cyst of the palatine tonsil with marked stridor and epigastric retractions which had begun after birth in a two-month-old male. The cyst was found to originate in the lower pole of the left palatine tonsil and almost occupy the entire pharynx. The cyst was removed orally without remarkable hemorrhage. The cyst was 20×15×15mm in size and contained 10ml of serous secretion. Histopathologically the wall of the cyst was covered by the squamous epithelium with little round cell infiltration in the stroma.
    We collected ten such cases reported in the Japanese literature and discussed the etiology of the cyst.
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  • A Case of a Sewing Needle Foreign Body in the Pharyngeal Wall
    Izumi Harada, Yasuo Sakakura, Hiroshi Mitsui, Masahiko Kubo, Masashi I ...
    1981 Volume 74 Issue 5special Pages 1349-1354
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1349
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    A case of a pharyngeal foreign body was reported with a review of the literature. A 19-year-old woman voluntarily swallowed a sewing needle. Though the foreign body was invisible in the pharyngeal region, X-ray examination revealed a concealed needle in front of the second cervical vertebra. Under general anesthesia with tracheotomy, the patient was placed in the supine position, with the head excessively extended. The concealed needle in the suspected area which was surrounded by Ligaclips® on three points was confirmed by an image amplifier. The needle was removed from the posterior wall of the pharynx perorally. The psychiatrist pointed out that she was irritable and emotionally unstable.
    We analyzed 49 cases of foreign bodies in the pharynx and esophagus treated in the Department of Otolaryngology, Mie University Hospital during the period of 1975-1980, as well as 5 cases of concealed needles in these areas reported in the Japanese literature.
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  • A Report of Carotid Body Tumor
    Masashi Inagaki, Yasuo Sakakura, Mikikazu Yamagiwa, Yuichi Majima, Yuk ...
    1981 Volume 74 Issue 5special Pages 1355-1363
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1355
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    A 53-year-old female was admitted to the Department of Otolaryngology, Mie University Hospital, complaining of a right submandibular tumor existing over two years. The right carotid angiogram revealed a typical, O-shaped carotid body tumor image in the carotid bifurcation. In July 1980 surgery was performed with the patient under general anesthesia. The tumor was 2×3×4.5cm in size and 16.2g in weight. No remarkable neurosurgical deficits were present on the following day.
    After five months the postoperative blood pressure returned to the preoperative level. The preoperative catecholamine level in the urine had been slightly higher than normal. However, it was found postoperatively to be within the normal range. It is suggested that this tumor may have been a functional carotid body tumor.
    We added 13 cases of such tumors to the statistics reported by Iwahashi et al. in 1970 and discussed the diagnosis and treatment of this tumor.
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  • Two Cases of Plummer's Disease
    Masuichi Ohi, Yasuo Sakakura, Teruhiko Harada, Tsuyoshi Nakagawa, Ryui ...
    1981 Volume 74 Issue 5special Pages 1364-1371
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1364
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    Although there are many types of hyperthyroidisms, Plummer's disease is a rare illness. This disease displays the symptoms of autonomous thyroid adenoma or adenomatous goiter, which is independent of the TSH and free of the hypothalmus-hypophyses regulation. Thyroid scintigraphy is widely used in the diagnosis of Plummer's disease, which shows the characteristic “hot nodule”. More information is obtained by both TSH depression and stimulation tests. The radioiodine concentration of the hot nodule is not affected by the former or the latter test, while that in the normal thyroid tissue, although it is initially low because iodine uptake is suppressed due to overproduction of thyroid hormone, increases until it can be visualized on scintigraphy by the latter test. Hemithyroidectomy is thought to be the most prevalent therapy for this disease.
    We report here two cases of this disease. The patients were 21- and 26-year-old females who had painless swelling in the anterior neck. They were revealed to have Plummer's disease on thyroid scintigraphy and underwent hemithyroidectomy and have had no symptoms attributable to the thyroid for four years and 12 months after surgery, respectively.
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  • A Case Report of a Bronchial Foreign Body Removed by the Fogarty Catheter
    Kunio Shoji, Haruki Fukuo, Yasuo Sakakura, Yasuro Miyoshi
    1981 Volume 74 Issue 5special Pages 1372-1376
    Published: May 15, 1981
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.74.5special_1372
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    A method for endoscopic removal of foreign bodies in the bronchial tree using the Fogarty balloon catheter is described. The patient was a 13-month-old boy whose brother had stuffed small stones into his mouth and then thrust them down. Dyspnoca and cyanosis developed at the time of the accident. On examination, there was no respiratory distress; however, X-ray examination revealed that there were two stones in the left bronchial tree and ten or more stones in the stomach.
    The larger stone in the left main bronchus was removed by a grasping forceps through a ventilation bronchoscope. The smaller stone fixed in the lower lobe bronchus could not be removed endoscopically. Further endoscopic removal was successfully performed using a Fogarty balloon catheter, which is 0.8mm in diameter with a balloon at the top. Under fluoroscopic guidance, the catheter was passed through a gap between the stone and the bronchial wall to the periphery and the balloon was filled with contrast material. By withdrawing the catheter the stone was pulled up to the main bronchus and was removed successfully by a grasping forceps.
    Because of this experience, we recommend this procedure before considering thoracotomy for the removal of a foreign body which cannot be removed by the usual endoscopic procedure.
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