(1) The endolymphatic sac operation was performed on 28 ears with Meniere's disease. At the operations, the endolymphatic sac was drained in 16 ears (Drainage Group). In the other ears, simple mastoidectomy and uncovering of the posterior cranial fossa dura were conducted (Mastoidectomy Group).
The results were evaluated one year after the operations with respect to vertigo. Vertigo was successfully controlled in 82.9%. No difference was found between the above two groups.
(2) The vestibular aqueduct was studied using temporal bone tmography. One hundred and eight ears with Meniere's disease served as subjects. The vestibular aqueduct was identified in 48.1% of the healthy ears, and 42.6% of the sick ears.
There was a correlation between the visibility of the vestibular aqueduct on tomography and the development of the endolymphatic sac.

View full abstract

A case of voluntary nystagmus has been reported with electronystagmographic interpretations. The patient was a 6-year-old boy without ophthalmologically or neurologically pathologic findings. Temporal bone films and brain CT-scan were normal. Nystagmus was conjugate, horizontal and jerky with an amplitude of about 10° and a frequency of about 5 to 6 per second. Fixation on an object was necessary for its initiation and maintenance, but convergence was not essential. Nystagmus was eliminated on eye closure. Fatigue limited the duration of voluntary nystagmus. The eye tracking test revealed borderline waves and optokinetic nystagmus was partially inverted bilaterally.
We feel that voluntary nystagmus should be classified into two types, one of congenital origin, the other caused by acquired factors. It is suggested that our case belongs to the so-called congenital nystagmus.

View full abstract

A 31-year-old man who suffered from vomiting, vertigo and sore throat was examined. As a result of cochlear and equilibrium tests, vertigo was found to be mainly due to the disturbance of the vestibular branch of the 8th nerve. Furthermore, the test for optokinetic nystagmus and that for eye tracking showed a slight abnormality, which indicated the simultaneous presence of functional disorder of the central nervous system. Virological-serological examinations revealed an increased count of the complementfixing antibody titer of herpes simplex. Vertigo recurred with reappearance of positional nystagmus and disorders of the oculomotor system and was accompanied by an increased titer of the above-mentioned antibody.
From these findings, the following conclusions were drawn: Herpes simplex infection can be an etiological factor of vestibular neuritis, and moreover, it is possible that it affects part of the central nervous system related to equilibrium function, e. g. the brain stem.

View full abstract

The tympano-mastoid surgery for chronic otitis media in children can be completely successful in restoring the structure and the function of the middle ear. Our methods and the results were described. Microscopic surgery is useful for the removal of extensive cholesteatomas in children, in the first or at least in the second stage operation. More careful postoperative observation accompanied by minor surgical intervention is necessary with children than with adults until the age of adolescence. There is no indication at all for radical operation on the middle ear which would result in a life-long conductive hearing loss of 50-60dB, and a frequent recurrence of aural discharge.

View full abstract

A case of the Hunt syndrome with multiple cranial nerve palsies is reported. A man of 67 came to the hospital complaining of dysphagia. Ten days before the consultation, he had severe right temporalgia for no special reason; 6 days beforehand, dysphagia, hoarseness and right tinnitus; and 2 days beforehand, he was hospitalized at another hospital. During the hospitalization nausea and vertigo appeared, but there was no loss of hearing. Examination revealed right 5th, 8th, 9th and 10th cranial nerve involvement with eruptions on the right auricle. Two days later, he developed right facial palsy.
Remission in all symptom manifestations was seen except for slight facial nerve palsy and recurrent nerve palsy after six weeks of treatment.

View full abstract

Rhinogenous optic neuropathy includes the optic nerve disturbance caused by paranasal sinusitis and by paranasal sinus cysts. The optic nerve is disturbed mainly because of inflammatory infiltration from paranasal sinus in the former case and compression by a paranasal sinus cyst in the latter.
We had 14 cases of paranasal sinus cysts accompanied by visual disturbance during the period from 1975 to 1980. We investigated the relation between clinical findings and the recovery of visual disturbance.
Even after both surgical treatment through the transnasal approach and drug treatment with antibiotics and adrenocortical steroids, four patients gained no improvement in visual disturbance. We found that these four cases had additional three findings.
1. Visual acuity before treatment had been reduced to light sensation or null.
2. Accompanying meningeal irritation syndrome. (headache, fever, nausea and vomiting)
3. Contents of the cyst were purulent.

View full abstract

Twenty-six cases of rhinogenic exophthalmos and neuritis retrobulbaris mainly due to muco- or pyo-cele of paranasal sinuses were reported. In addition to exophthalmos, the following ocular findings were described: visual disturbance, contraction of the visual field and retinal fold or elevation which may have been caused by retinal vascular disorder due to the compression by orbital space-ocupying lesions. For the treatment of neuritis retrobulbaris, ophthalmological approaches are recommended prior to surgery of the nose and paranasal sinuses. Staging of surgery, drainage and, then, decompression of the optic nerve, are advisable especially in purulent sinusitis. Emphasis was placed on close cooperation between rhinologists and ophthalmologists in treating rhinogenic orbital diseases.

View full abstract

Serum IgE values were examined in 366 patients with allergic rhinitis with/without bronchial asthma or allergic dermatitis.
The patients consisted of 270 cases of allergic rhinitis (Group I), 71 with rhinitis and bronchial asthma (Group II), 9 with three of them (Group III) and also 16 with bronchial asthma.
The serum IgE level was more than 500IU/ml in 49.3 per cent of Group I, and the mean value was 783.7IU/ml (SD 840.1), while that was 74.6 per cent of Group II with a mean of 1769.0IU/ml (SD 1474.9).
The elevated IgE value was insignificant in the case of Group I, but Group II and III had significantly high IgE levels.
Patients aged from eleven to fifteen had a higher IgE level (1389.9IU/ml, SD 1074.0) than other ages in Group I, but the IgE level in Group II was not related to any age groups.
The serum IgE level was not related to sex or the type of allergens, and had no influence upon the degree of eosinophilia or the responsiveness to the provocative nasal test.
In only three per cent of Group I the serum IgE level was over 3, 000IU/ml. A patient with elevated IgE over 3, 000IU/ml has a possibility of having an other allergic disease in addition to rhinitis, or the person may develop other disease besises allergic rhinitis in the future.

View full abstract

A case of Weber-Christian disease accompanied by a laryngeal ulcer was reported with a review of the literature. The patient was a 59-year-old female who complained of remittent fever, mucocutaneous nodules, swelling of the right cheek, and sore throat. Soon after the diagnosis of Weber-Christian disease was made by histological examination, labolatory findings, and the clinical picture, treatment with prednisolone was initiated. Responding to the steroid hormone, the laryngeal ulcer showed a tendency to heal, along with a striking clinical improvement of the other symptoms. Based on these findings, it is very likely that the laryngeal ulcer is a partial clinical symptom of Weber-Christian disease. Regarding the etiology of the disease, a special reference to the autoimmune disease is made.

View full abstract

As 42-year-old woman complaining of swelling in the left parotid gland region for past two years, was admitted in our department for surgery in June 1979. By bimanual palpation, we suspected a left parotid gland tumor which extended into the parapharyngeal space. This diagnosis was confirmed by the aids of sialography and CT scanning. As surgical procedure, we chose an external approach and could remove a “Dumb-bell type” mixed tumor without injuries of the facial nerve and palatal mucosa. From the experiences of this case and other two cases treated before in our department, discussions were made on the diagnosis and surgical treatment for this sort of tumor of the parotid gland.
Clinical and surgical findings of a 42-year-old woman, who complained of swelling of the parotid gland region of the left side and showed a dumb-bell type of the mixed tumor, were discussed with the emphasis on the following points:
(1) For the detection of a dumb-bell type of the parotid gland tumor, bimanual palpation of the tumor is useful. Furthermore, CT scanning is also useful for the detection not only of the tumor of this type but also of its extending to the parapharyngeal space.
(2) Among various surgical methods of a dumb-bell type of the tumor, external approach seems most suitable, since injuries of the vessels of the parotid gland, palatanal mucosa and facial nerves can be avoided when this approach is adopted.

View full abstract

Using binocular Iriscorder the pupillary reflex to the light was analyzed in 49 healthy, normal subjects and normal values of 10 factors of direct and indirect pupillary reactions were determined.
The above-mentioned normal values were further discussed, with regard to several factors, such as age, duration of stimulation and state of adaptation of the pupil to the light.
From a series of examinations, the following facts were noted:
(1) No significant differences between the direct and indirect pupillary reactions were observed, with regard to 9 factors of the light reflex, with the exception of pupil dilatation time.
(2) It was found that the longer the duration of stimulation, the stronger the contraction, and the dilatation phases of the light reflex were more marked in dark adaptation than in light adaptation.
(3) It was also found that in aged people, the activity of the pupil was under adrenolytic and/or cholinergic conditions.

View full abstract

The aim of the present experiment was to investigate whether the histochemical characteristics were changed after cross-innervation of laryngeal muscle.
Buller et al. and others have shown that dark muscle becomes light by sectioning and cross-uniting the nerves to dark muscle. These findings were confirmed in rabbits by our preliminary study.
The present experiment was divided into two parts: implantation of a cricothyroid muscle block with an external branch of the superior laryngeal nerve in the denervated thyroarytenoid muscle (Group 1) and in the denervated posterior cricoarytenoid muscle (Group 2) after severance of the recurrent laryngeal nerve.
The experiment showed that the reinnervated thyroarytenoid muscle of Group 1 and the posterior cricoarytenoid muscle of Group 2 histochemically resembled the cricothyroid muscle on succinic dehydrogenase staining.
It is concluded that the histochemical property of the cross-innervated muscle as appearing on succinic dehydrogenase staining is determined neurally.

View full abstract

Fourty two cases of peripheral facial paralysis were devided into three groups, and were administered Steroid, CH₃-VB₁₂, and Steroid plus CH₃-VB₁₂ respectively. The effect of these drugs on recovery of facial paralysis was determined using the paralysis score method that had been proposed by Yanagihara (1977), and the integrated EMG method that had been proposed by Yagi (1980).
In the case of complete recovery, rated paralysis score and the values of the integrated EMG usually increase linearly. By means of regression analysis, regression line around each value could be determined using the following equation.
Y=B·log X+A (Y=score, B=rate of recovery, X=day, A=constant)
If we assume Y=100%, X shows the number of days taken for complete recovery and constant B, a rate of recovery.
Days taken for complete recovery in Steroid, CH₃-VB₁₂ and Steroid plus CH₃-VB₁₂ were 67.3, 54.9 and 40.3, and the rate of recovery 80.7, 92.2 and 112.3 respectively.
Third group, one that was administered Steroid plus CH₃-VB₁₂, took shorter period of time for complete recovery than the other two groups. It is statistically significant. This means that Steroid and CH₃-VB₁₂ had a synergistic effect upon recovery of facial paralysis.

View full abstract

Fundamental and clinical investigations with Ceftizoxime, a new cephalosporin derivative, were performed with the results which might lead to the following conclusion:
1) In vitro antibacterial activity: The minimum inhibitory concentration of Ceftizoxime was tested by an agar plate dilution method. Ceftizoxime results in excellent, broad spectrum antibacterial activity against standard strains of various bacteria. Ceftizoxime had same antibacterial spectrum like those of other cephalosporin antibiotics. The MIC of Staphylococcus aureus isolated from otorrhea was distributed at a range from 0.39 to 50μg/ml of Ceftizoxime, showing its peak at 3.13μg/ml. Other strains of Proteus mirabilis, Escherichia coli, Klebsiella pneumoniae were inhibited by ≤0.2 to 3.13μg/ml of Ceftizoxime. Ceftizoxime showed the MICs of 3.13 to ≥100μg/ml, its peak at 25μg/ml against 60 strains of pathogenic Pseudomonas aeruginosa.
2) Concentration in serum: The serum level of Ceftizoxime in healthy adults given 500mg reached a maximum of 32.9μg/ml at 15 minutes after intravenous injection. Even 6 hours after intravenous injection, clinically effective serum Ceftizoxime concentration 0.7μg/ml was still demonstrable.
3) Concentration in tissues: Activity of Ceftizoxime was demonstrable at the concentration of 3.0μg/g in human palatine tonsilla and 2.5μg/g in mucous membrane of maxillary sinus one hour after intravenous injection, when the serum concentration of Ceftizoxime was 14.5 and 14.8ug/ml, respectively.
4) Results of clinically treatment: When Ceftizoxime was intravenously injected to 26 cases of representative infection in the otorhinolaryngologic field, clinical results were excellent in 22 cases good in 3 cases and fair in one case. When the excellent and good cases were considered together, clinical response were obtained in 22 cases, 96.2 per cent.
Side effect: No side effect was shown with intravenous injection of Ceftizoxime.

View full abstract