Practica Oto-Rhino-Laryngologica

Inner Ear Otosclerosis

Takashi Tsuiki

1982 Volume 75 Issue 2 Pages 305-315
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.305

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The idea that sensorineural hearing loss without an associated conductive loss due to stapes fixation can be attributed to otosclerosis is presented.
The literature on sensorineural hearing loss in otosclerosis is reviewed. Although a considerable number of related findings seems to support this idea, no confirming evidence has been found.
It has been believed that otosclerosis is rare in Japan and many otologists are uninterested in the idea of inner ear otosclerosis. Recently, however, some investigators reported a considerable number of patients with clinical and/or histological otosclerosis.
There are many cases of sensorineural hearing loss of unknown cause and its etiology has been a matter of concern.
As inner ear otosclerosis is clinically characterised by sensorineural hearing loss of unknown origin, it should be included in differential diagnosis when evaluating the etiology of sensorineural hearing loss in general.

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Stapedial Reflex in Peripheral Facial Paralysis

Nobuya Yagi, Tatsuya Fukazawa

1982 Volume 75 Issue 2 Pages 317-325
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.317

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Since the stapedial muscle is an extraposed facial muscle, stapedial reflex should show a parallel change with that of the facial muscles.
In the case of facial paralysis, stapedial reflex, like the Score Rating Method (May, 1975, Yanagihara, revised in 1977) and the Integrated EMG Method (Magi, 1980), reflects the degree of facial nerve damage.
The stapedial reflex of an affected side induced by contralateral stimulation was compared with that of the unaffected side, and was expressed in a percentage, which we regarded as the degree of facial nerve damage.
Three methods, namely the Score Rating Method, Integrated EMG Method and stapedial reflex were administered to 33 cases of peripheral facial paralysis. By applying the values measured in each method in a regression analysis, the onset of recovery and the termination date were determined.
In the case of complete recovery, the stapedial reflex had late onset but its recovery rate was high and showed complete return. In the case of incomplete recovery, the stapedial reflex had late onset but it had a more rapid rate of recovery than that of the Score Rating method.
The distribution of values of onset of stapedial reflex and the Score Rating method had a good correlation with that of the diameters of the fibers in the facial canal. The stapedial muscle is innervated by small fibers and stapedial reflex has a late onset, because in smaller fibers, injury is severer and recovery tends to be stagnated.

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A Case Report of Cardiac Arrest by Xylocaine Injection for Tympanoplasty

Eiichi Fujimura, Etsuo Yamamoto, Morio Yamauchi, Ryoichi Nomura

1982 Volume 75 Issue 2 Pages 327-335
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.327

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This is a report of a 20-year-old female, suffering from right-sided chronic otitis media, who was operated on under local anesthesia. In the course of operation, the patient became irritable and epileptic. Cardiac arrest then ensued. These conditions appeared just after the local anesthesia was established with 14ml lidocaine. The patient was treated by our anestheologists and successfully resuscitated. No postoperative trouble has appeared to date.
From the retrospective study of the patient history and literature, the following conclusions were drawn:
1) The patient had a past history of psychomotor seizure. Lidocaine has a pharmacological property of inducing psychomotor seizure. It is therefore, concluded that the patient was hypersensitive to lidocaine.
2) Pretreatment with diazepam is effective in preventing lidocaine-induced seizures. Before the onset of lidocaine-induced seizures in a nontreated patient, drowsiness, apprehension, or excitability usually appear. Prior administration of diazepam suppresses these symptoms. If seizures occur in the pretreated patients, it will be difficult to control them.
3) During ordinary resuscitation, seizures are treated by barbiturates, and ventricular fibrillation by intravenous lidocaine. Diazepam is more effective than barbiturates. The ventricular fibrillation occurring under local anesthesia should be treated by lidocaine, because ventricular fibrillation usually results from the untoward effect of the epinephrine contained in local anesthetics as evidenced by the literature.
Therefore, intravenous injection of diazepam and lidocaine is the first choice for convulsions and tachyarrhythmia. Lidocaine containing norepinephrine has no cardiac effect.
For the purpose of making the blood vessels contract, norepinephrine is a better accompaniment to lidocaine because it has less cardiac effect than epinephrine.

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Pathophysiology of Positional Vertigo of Malignant Paroxysmal Type (Bruns Syndrome, Das akute Unterwurm-Syndrom)

Eiji Sakata, Chigiri Kanazawa, Kyoko Ohtsu, Akinori Itoh, Kunio Takaha ...

1982 Volume 75 Issue 2 Pages 337-348
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.337

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It is well known that paroxysmal positional vertigo is induced by change of head position and subsides immediately when the head is returned to the original position. There are two types of paroxysmal poaitional vertigo. One is what Dix and Hallpike call the benign type, which is thought to be caused by otolith lesions. Another is a malignant type in contrast to the former. It is related to lesion in the central nervous system. Otologists are usually familiar with the former, but the latter is not known even among neurologists or neurosurgeons.
We have experienced 37 cases of the malignant type of paroxysmal positional vertigo. They included three cases of metastatic tumor of the cerebellar vermis, six cases of subacute late cerebellar cortical atrophy, five cases of olivo-ponto-cerebellar atrophy, three cases of alcoholic cerebellar atrophy, two cases of post-traumatic cerebellar atrophy, five hematomas of the cerebellar vermis, eight hematomas of the cerebellar hemisphere, two abscesses of the cerebellar hemisphere, two medulloblastomata and one meningioma of the cerebellar vermis.
Bruns emphasized two important aspects of the syndrome: 1) vertigo, vomiting, headache and visual disturbance on changing the posture of the head; and 2) freedom from symptoms between episodes. Alpers et al. added a third feature: 3) a constant anterior flexion of the head in most cases, usually at the midline but at times with lateral flexion and rotation. To the above three features of the symptom-complex described by Bruns and Alpers et al., we propose to add a fourth feature: 4) patients usually take a head posture with the affected side down, and if they change the head posture to having the non-affected side down the symptoms tend to be intensified greatly.
This symptom-complex has been called “Bruns syndrome”, “Das akute Unterwurm-Syndrom” or “retarded type of benign paroxysmal positional vertigo”, and confusion and misunderstanding exist about this syndrome. We propose to apply to this syndrome a uniform name of “paroxysmal positional vertigo of malignant type” in contrast to the benign type.
The mechanism of the malignant type is usually understood to be intermittent hydrocephalus through blockage of the ventricular system (Bruns, Oppenheim), or derangement of the normal vestibular mechanisms (Alpers et al.). In contrast to these traditional speculations, we consider it to be attributed to the disturbance of the function of the vestibulo-cerebellum (i. e. nodulus and flocculus), which plays a role of inhibiting the vestibulo-ocular system. The characteristic feature of astasia should be emphasized, and we named it “Spinnenkriechen-Syndrom.”
The lesion of the cerebellar vermis usually presents poor neurological signs except truncal ataxia; therefore, topographical diagnosis to locate this region is sometimes very difficult. To understand and know this symptom-complex mentioned above may lead to the topographically correct diagnosis of the lesion in the cerebellar vermis.

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A Case of Congenital Epulis Which Decreased in Size

Masanao Ohkawa, Michiaki Hiramoto

1982 Volume 75 Issue 2 Pages 349-355
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.349

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Congenital epulis occurs on the gum pads of infants, and is cited in the literature to be relatively rare. Since Neumann had made the first report of congenital epulis in 1871, about 140 cases have been reported throughout the world.
A 10-day-old Japanese female infant had a 15mm×15mm×17mm epulis on the right anterior maxilla, and it decreased in size in three months without therapy. This clinical course is a highly unexpected phenomenon. This paper also reveals that the pathological findings of congenital epulises (whether epulis has granular cells or not) depend on the period of resection as evidenced in the concerned Japanese reports.

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CT-scanning in Otolaryngology

Part 2. Examination of parotid tumors

Jun Kusakari, Satomi Endo, Akira Hara, Takatoshi Hanajima, Syo Hashimo ...

1982 Volume 75 Issue 2 Pages 357-360
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.357

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Combined computerized tomography-sialography was performed in 28 patients with parotid tumors. Sialography was performed in the usual fashion. After confirming the presence of the contrast material within the parotid gland by X-ray, 4 to 5 scannings were done at the width of 10mm below Repid's base line. With this procedure, the parotid gland was clearly demonstrated and the location of the tumor was shown as a shadow defect. Although the nature of the tumor, especially whether it was malignant or benign was difficult to predict, the CT-findings regarding the size and location of the tumor were completely coincident with the operative findings in all the cases. Accurate appraisal of the relation between the tumor and the facial nerve was possible in all but two cases. The preoperative information obtained from CT-scanning is extremely useful in the case of parotid tumor surgery.

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Diuretic-induced Change of Electrocochleography (AP, SP) in the Guinea Pig

Akira Kanoh

1982 Volume 75 Issue 2 Pages 361-392
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.361

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Cochlear injury was produced using furosemide. Electrical and histological changes were then examined. The experiments were carried out using guinea pigs anesthetized intraperitonealy with Nembutal 10mg/kg body weight. The animals breathed spontaneously through the experiments. The left cochlea was exposed by the classical ventrolateral approach and the silver ball electrode was placed on the round window to record Cochlear responses. The right jugular vein was cannulated for intravenous injection.
Three experiments were designed. 1. Acute experiments: AP and SP were persuited immediately after furosemide (100mg/kg, 50mg/kg, 25mg/kg) was injected through the cannule. 2. Chronic experiments: Furosemide (100mg/kg) was injected intraperitoneally at weeks 1, 2 and 6, and input-output curves of AP were examined, thereafter. 3. AP and SP were persuited immediately after furosemide (50mg/kg) was injected through the cannule of the animals whose OHCs had been injured with Nitromin (10mg/kg) seven days beforehand. The results are as below. In the acute experiments, the AP amplitude drops or disappears transiently and recovers in 10-20 minutes. The polarity of SP, originally positive, turns negative and in 10-20 minutes it turns positive again. In the chronic experiments, the recruitment phenomenon was seen in the animals that received administration at week 6 especially on 8KHz sound stimulation. Positive SP is not recorded from the round window when OHCs were injured.
Histologically, in the acute experiments, the stria vascularis is edematous through all turns. In the chronic experiments the stria vascularis shows slight edematous changes and balloon-like changes are seen in outer sulcus cells. However, the OHCs and IHCs seemed intact.

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A Double-blind Controlled Study on the Antivertiginous Dose Effects of ATP in Patients with Vertigo and/or Dizziness

Isamu Watanabe, Jin Okubo, Tsuneyuki Oku, Kanemasa Mizukoshi, Yukio Wa ...

1982 Volume 75 Issue 2 Pages 393-415
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.393

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The antivertiginous dose effects of ATP were evaluated, in a double blind control study comparing between the dose of 300mg and of 150mg daily for four weeks in 168 patients with the peripheral vestibular disorders.
1. Materials: 69 cases with Meniere's disease, 18 cases with benign paroxismal positional vertigo, 5 cases with vestibular neuronitis, and 62 cases with the other similar and marginal diseases to Meniere's disease were selected.
2. Methods: The clinical subjective signs and symptoms in these cases were evaluated every two-weeks both by the doctors and patients themselves. The objective symptoms in the equilibrium and auditory examinations were also evaluated at the first examination before prescribing treatment, the second after two weeks, and the last after four weeks, by the same doctors. Each medication was designed in matched pair group method for the double control trial. Each patient was examined by the same doctors to eliminate variation in interpretation of the status of the patients conditions prior to the control study, and was also evaluated by the same doctors and the Committee of the Data Fixation, restpectively.
3. Results: The statistical comparison between the antivertiginous drug effects of 300mg and of 150mg ATP daily for four weeks showed that the 300mg dosage was significantly more preference than the 150 dosage in the subjective and objective grobal evaluations in the patients with peripheral vestibular disorders. However, no significant preference between the two dosages was revealed in the subjective symptoms except in headache. The confrontation between the two dosages, on the other hand, showed more significant difference in spontaneous nystagmus, positional nystagmus and caloric nystagmus examinations. Side-effects were minimal, and only four patients reported tinnitus, sleepy, stomatitis and constipation.

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A Comparative Double-blind Evaluation of a New Continuous Acting Preparation of Amoxicillin (C-AMOX) in Acute Tonsillitis

Shunkichi Baba, Kenji Wada, Tsutomu Hatano, Kanetaka Murai, Haruji Kin ...

1982 Volume 75 Issue 2 Pages 417-433
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.417

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A double-blind study was performed in order to evaluate the efficacy and safety of continuous acting preparation of Amoxicillin (C-AMOX) (1, 000mg/day b. i. d.) as compared with Amoxicillin capsule (AMPC) (1, 000mg/day q. i. d.) in acute tonsillitis, and the following results were obtained.
1) The overall efficacy of C-AMOX and AMPC were 90.4% and 76.0%, respectively, and there was no statistically significant difference between the two drugs.
2) Global improvement rating by doctors, however, was 98.1% for C-AMOX and 78.1% for AMPC. C-AMOX tended to be more effective than AMPC and the rate of usefulness of C-AMOX was also significantly higher than that of AMPC.
3) The incidence of adverse reaction was 5.4% in 56 cases with C-AMOX and 9.3% in 54 cases with AMPC. No significant difference was observed between the two drugs.
The results indicate that C-AMOX showed significantly higher efficacy and usefulness, and that C-AMOX was the same as or tended to be more effective than AMPC in the therapy of acute tonsillitis.

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[title in Japanese]

[in Japanese]

1982 Volume 75 Issue 2 Pages 435-438
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.435

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[title in Japanese]

[in Japanese]

1982 Volume 75 Issue 2 Pages 439-441
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.439

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[title in Japanese]

[in Japanese]

1982 Volume 75 Issue 2 Pages 442-444
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.442

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[title in Japanese]

[in Japanese]

1982 Volume 75 Issue 2 Pages 445-447
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.445

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[title in Japanese]

[in Japanese]

1982 Volume 75 Issue 2 Pages 448-450
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.448

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[title in Japanese]

[in Japanese]

1982 Volume 75 Issue 2 Pages 451-452
Published: 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.451

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