Practica Oto-Rhino-Laryngologica

Middle Ear Disease and Middle Ear Effusion in Cleft Palate Patients

Yasutoshi Hosomi, Mayuki Gotoh, Etsuo Yamamoto, Nobuhiko Isshiki

1983 Volume 76 Issue 5 Pages 1377-1381
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1377

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Effects of the palate correction on cleft palate patients were examined by checking middle ear effusion of the two groups of pre- and post-operative patients. The results are as follows.
(1) In the pre-operative group (0-2 years of age), 33% of ears contained middle ear effusion.
(2) In the post-operative group (3-28 years of age), 7% of ears contained middle ear effusion.
(3) Bacteriological examination revealed microorganisms in 60% of the effusions.
These findings suggest that bacterial infection is a important factor of middle ear disease in cleft palate patients.

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Five Cases of Malignant Tumors of the Auditory Organ

Yoshio Umetani, Toru Minatogawa, Toru Inamori, Haruo Wakutani, Hiroshi ...

1983 Volume 76 Issue 5 Pages 1383-1390
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1383

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Five cases of carcinoma of the auditory canal and middle ear treated in the period from 1976 to 1981 at the Hyogo Medical College were presented. The primary site of one case was presumed to be in the middle ear and the other 4 were to be in the external auditory canal. Pathologically, one of them was an adenoid cystic carcinoma and the others were squamous cell carcinomas.
These patients were treated primarily with operation and radiation and chemotherapy were administered additionally. Although good results were obtained in 2 cases with chemotherapy, wide resection should be the first choice because it makes postoperative treatment easier.

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A Case of a Foreign Body in the Sphenoidal Sinus

Tomohiro Anzai, Kohsei Ohtsuki, Masafumi Murakami, Hideo Imaizumi, Iwa ...

1983 Volume 76 Issue 5 Pages 1391-1397
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1391

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A man aged 38 was shot accidentally by a shotgun. A pellet went through the lelt anterior nares and lodged in the left sphenoidal sinus. Sixteen days thereafter, the pellet was removed by a combined maxillary sinus and endonasal approaches, using an image intensifier.
The literature report of foreign bodies in sinus cavities. They are frequently found in the maxillary and ethmoidal sinuses but rarely in the sphenoidal sinus. The pellet of our patient entered the sphenoidal sinus through the anterior nares. This is a very rare case in Japan.

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A Case of Rhinolithiasis

Mitsutake Tani, Kuniyuki Yamamoto

1983 Volume 76 Issue 5 Pages 1399-1403
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1399

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A case of rhinolithiasis was reported. The patient was a 56-year-old female, who complained of left nasal obstruction, purulent nasal discharge and headache. Anteriorrhinoscopy revealed a large grayish white mass blocking the left nasal cavity. X-ray examination revealed a calcified mass occupying the left nasal cavity which was 3.0×3.6×1.6cm in size. Diagnosis of rhinolithiasis was made. This mass was removed surgically piecemeal by an endonasal approach under local anesthesia. Chemical analysis of this mass showed it to be composed of calcium phosphate and calcium carbonate.

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Clinical Observations on Carcinoma of the Nasal Cavity

Takashi Kondo, Yoshitaka Kawabe

1983 Volume 76 Issue 5 Pages 1405-1412
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1405

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From 1965 to 1978, we encountered 13 cases of carcinoma of the nasal cavity, which were statistically observed and found to be 6.7% of all the tumors of the nose and paranasal cavities.
Nasal cavity tumors are rather small in number, but they are pathologically quite rich in character. It has been revealed that nasal cavity tumors hold a special position in the classification of tumors. Adequate treatment for carcinomas of the nasal cavity demands a thorough evaluation of the site of origin and route of spread of the tumor.
Since these lesions tend to remain localized, the problem is principally one of local control of the disease. Failure to achieve local control seems to reflect initial underestimation of the extent of the disease. In general, nasal cavity tumors have favorable prognoses compared with the tumors of the paranasal sinuses. The five-year crude survival rate was 60.0%.

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Influence of Atmospheric Factors on Incidence of Epistaxis

Hitoshi Sasaki, Jiro Hozawa, Keiji Fukuoka, Izuru Nozawa, Takehiro Kaw ...

1983 Volume 76 Issue 5 Pages 1413-1422
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1413

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Two hundred and twenty-eight patients of epistaxis were treated in Hakodate Municipal Hospital from July in 1980 to June in 1981. The patients' ages ranged from 0 to 70 years. There were 130 males and 98 females.
The origin of epistaxis was classified into local (37.1%), systemic (28.7%) and essential causes (34.2%). For these patients, the relation between the incidence of epistaxis and weather conditions was investigated. As a result, a high incidence of epistaxis was observed to be closely connected with the following three atmospheric factors: i) dryness of the air, ii) approach of low atmospheric pressure and iii) passage of a cold front.
In the Hakodate district, high incidences of epistaxis were observed in January and in the period from March to April when there were frequent passages of cold fronts accompanied by low atmospheric pressure.

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A Patient Who Had Delayed Curative Course of Wound After CO₂ Laser Surgery

Mitsuru Furukawa, Hideyo Ishiguro, Yozi Ishibashi, Ryozo Umeda

1983 Volume 76 Issue 5 Pages 1423-1426
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1423

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Laser surgery is an excellent surgical technique. We employed CO₂ laser to remove the recurrent small cancerous tissue that developed in the post cricoidal area. The laser beam was irradiated via an operative microscope. At first, the focused beam was used for cutting the tumor and the defocused beam was employed subsequently to reduce the quantity of the tumor. Vaporization was useful for getting rid of the deeper part of the tumor.
No significant hemorrhage was observed during the operation.
However, because of delayed healing course of wound, a progressive necrotizing lesion occured after surgery. When the coating of necrotic tissue was detached spontaneously from the wound, massive bleeding happened and the patient died from shock. We discussed indications for laser surgery and pointed out factors which have close relations in healing of the wound.

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Reconstruction of the Head and Neck with the Pectoralis Major Myocutaneous Island Flap

Masahiro Tanabe, Koichi Ushiro, Takeo Kusumoto, Tomoyuki Haji, Tatsuro ...

1983 Volume 76 Issue 5 Pages 1427-1434
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1427

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The pectoralis major myocutancous island flap was used for head and neck reconstruction in six patients. Reconstruction was made on five of the patients following extirpative surgery of the oral cavity. The flap was also used in one patient for the reconstruction of a large defect in the submandibular region due to radiation necrosis. No loss resulted in any portion of the flaps in any of the patients. No complications were encountered.
The advantages of the pectoralis major myocutancous island flap are as follows. The flap has an excellent blood supply and is very reliable. Reconstruction can be performed in one stage. Large defects of tissue can be filled with the thick skin-subcutaneous-muscle complex. The muscle pedicle protects the carotid artery and restores the contour to the dissected neck. There is usually no need of skin grafting to the donor site.
The disadvantages of this flap are as follows. The thickness of the flap limits its use only to large tissue defects. The flap is problematic in cases with thick subcutaneous fat and muscle. The loss of the function of the pectoralis major muscle is inevitable. The bulkiness of the musule pedicle covering the neck has the potential of obscuring recurrent neck disease.
Although, this flap will probably become more commonly used, there may still be cases in which regional or other skin flaps are preferable to this flap.

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Comparative Ototoxicity Study of Aminoglycosides between Intravenous Infusion and Intramuscular Administration

With Special Reference to Gentamicin

Hitoshi Saito, Kazuo Uede, Toshiyuki Ono, Susumu Nakae, Yoshiaki Hiras ...

1983 Volume 76 Issue 5 Pages 1435-1452
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1435

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Comparative ototoxicity and nephrotoxicity studies of gentamicin between 60-minute intravenous infusion and intramuscular administration were carried out using a total of 36 rabbits. The following results were obtained:
At the dose of 30mg/kg, there was no difference in ototoxicity and nephrotoxicity between 60-minute intravenous infusion and intramuscular administration.
At the dose of 40mg/kg, almost similar ototoxicity was observed via both administration routes. However, deaths that are considered attributable to nephrotoxicity were found in more animals in the 60-minute intravenous infusion group than in the intramuscular administration group. This result indicates that the risk of ototoxicity may be secondarily increased by a retarded excretion of gentamicin.
The dose of 40mg/kg was considered to be the threshold to develop significant nephrotoxicity and ototoxicity by 60-minute intravenous infusion.

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Experimentally-Induced Round-Window Membrane Rupture in Guinea Pigs

a comparative study of hearing and cochlea histopathology

Hiroo Yanagihara

1983 Volume 76 Issue 5 Pages 1453-1470
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1453

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The initial part of the present investigation clarified the relationship between hearing impairment and the pathology of the cochlea in experimentally-induced round-window membrane (RWM) rupture. The auditory brain stem response (ABR) was employed to assess hearing of the animals. In 15 (56%) of the 27 guinea pigs, hearing loss immediately after the rupture remained within 10dB. In these animals, there was no injury of the organ of Corti, despite hemorrhage in the perilymphatic space. In 4 of the 7 animals which survived from 7 to 100 days, during which hearing loss was within 10dB immediatery after the rupture of the RWM, no further deterioration of hearing ensued, and there was no specific pathologic change in the cochlea except for hemorrhage of the perilymphatic space. The results indicated that the RWM rupture alone might not cause serious hearing impairment as long as the organ of Corti remained intact.
In the latter part of the present study, comparative histological study of the healing process of the RWM ruptures was performed in 13 guinea pigs using the fascia and the perichondrium. After the RWM was totally ruptured, it was closed with the temporal fascia in 6 guinea pigs and with the perichondrium in 7. One to three months after surgery, histological specimens of the RWM were obtained. Either the temporal fascia or perichondrium seemed to function as a “supporting guide” in closure of the RWM and the healing process of the RWM rupture with these materials were essentially the same. Complete absorption of these materials usually took three months.

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Age Changing Effect on the Vestibulo-Ocular Reflex in Humans

Shuji Sekine

1983 Volume 76 Issue 5 Pages 1471-1479
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1471

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The vestibulo-ocular reflex (VOR) helps to maintain a stable retinal image by generating compensatory eye movements so as to offset the effects of head rotation. The VOR gain in normal subjects in the dark is about 0.6 at a relatively low frequency range of pendular rotation. Recently, it has been reported that patients with cerebellar lesions such as cerebellar atrophy, in which the number of cerebellar neurons decreases, show high VOR agin compared to nomal subjects. In addition, it has been well-known that the population of cerebellar neurons gradually decreases with aging. From these, it is suspected that aging probably influences the VOR gain control. We examined the horizontal VOR gain in the dark at the frequency of 0.25Hz pendular rotation in each decade of age from zero, actually older than 5 years to the seventies, and also the adaptation of VOR gain to the horizontal vision reversal condition with right-left vision reversing prisms. The VOR gain in the dark was the lowest (0.59) in the subjects in their thirties and its gain gradually became higher with increasing age, for example 0.77 for those in their seventies. We found that in younger subjects the VOR gain was also very high compared to those in their twenties, thirties and forties. For example, in the youngest decade, i.e. from 5 to 9 years, the mean VOR gain was 0.84. The adaptation of VOR to reversing prisms, on the other hand, was not affected by aging.
From these results, we speculate that the VOR gain in humans is probably highest in newborns. In human life, this high VOR gain produces plastic changes (learning) because visual and vestibular inputs often conflict with each other. The high VOR gain in older subjects reflects the reduction of the inhibitory activity to the VOR arc from the cerebellar Purkinje cells due to the decrease in the population of neurons brought about by aging. Thus, we speculate that in the younger age the learning effect is predominant compared with the aging effect and in the older age the aging effect is predominant compared with the learning effect.

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Immunohistochemical Studies of Peptidergic Innervation in the Field of Otolaryngology

Part 1 Distribution of Peptidergic Nerve Fibers in the Middle Ear Mucosa and Eustachian Tube

Osamu Ninoyu, Toshio Yamashita, Hajime Amano, Nobuo Kubo, Tadami Kumaz ...

1983 Volume 76 Issue 5 Pages 1481-1489
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1481

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The peptidergic innervation of the guinea pig's middle ear mucosa and eustachian tube was studied by the immunohistochemical method.
Concerning the middle ear mucosa, we tested 4 kinds of peptide antibodies-SP, VIP, GRP, and APP. All of them stained well by either the FITC or PAP method. Most of these nerve fibers are found along small blood vessels, but some of them run independently. GRP is only scarcely distributed, while the other kinds are well distributed. However around the tubal tympanic oriffice, all four kinds of peptidergic nerve fibers were found in abundance.
The peptidergic innervation of the eustachian tube has already been studied concerning VIP and APP. In this paper, we tried and succeeded in displaying the SP nerve fiber distribution in the eustachian tube by either the FITC or PAP method. And we found that they are well distributed near the pharyngeal oriffice. Also we were able to find them in the subepithelial region and around blood vessels, but a little a round the tubal grands.
This innervation of peptidergic nerve fibers in the middle ear mucosa and eustachian tube was comparatively similar to the innervation of adrenergic and cholinergic nerve fibers.
SP, VIP and GRP were not affected by the resection of the superior cervical ganglion, but it caused a reduction of the APP nerve fibers in the middle ear mucosa.
As a result of this study, we can suggest that the peptidergic nerve fibers in the middle ear and eustachian tube have a vasomotor and secretory actions, and work with both adrenergic and cholinergic nerve fibers in preventing infection and in helping to remove mucous secretions from the middle ear.

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Effects of Cerocral on Vertigo Principally Meniere's Disease

Masahiro Mizuno, Tetsuo Kimura, Mamoru Miyata, Mamoru Morita

1983 Volume 76 Issue 5 Pages 1491-1498
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1491

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The clinical effects of Cerocral were studied on 16 patients with peripheral vertigo principally Meniere's disease, and these effects were assessed by subjective and objective parameters. The results obtained were as follows;
(1) Cerocral was effective in 80% of patients.
(2) As to the subjective symptoms, the frequency and intensity of vertigo and nausea and/or vomitting were prominently improved, and tinnitus, headache and shoulder stiffness were comparatively improved.
(3) As to the objective parameters, the stepping test and positional nystagmus test were also prominently improved.
(4) No sereous side-effects were observed.
Thus, Cerocral seemed to be effective and safe for treatment of peripheral vertigo.

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Effectiveness of Treatment with Mequitazine (LM 209) for Allergic Rhinitis

Akira Tamada, Naoyuki Kano, Masanao Ohkawa, Mitsuharu Nonomura, Masata ...

1983 Volume 76 Issue 5 Pages 1499-1504
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1499

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LM 209 is a new product of antihistamine to treat allergic diseases. We investi-gated the antiallergic activity of LM 209 for allergic rhinitis, using 24 patients appeared in the ENT clinic of Kyoto University Hospital and Nagahama Red Cross Hospital from Spring to July, 1982. This drug was given to each patient for 3 weeks continuously. The results obtained were as follows.
1) The effectiveness for sneezing, watery rhinorrhea and nasal obstruction was 79.2, 66.7 and 33.3% respectively.
2) Overall effectiveness for allergic rhinitis was 66.7%, including seasonal and perennial types.
3) The side effect of drowsiness and tiredness was minimal, for which a long term administration was feasible.

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Clinical Evaluation of AZ-S Tablet in the Treatment of Pharyngitis

Yasuo Harada, Kohji Yajin, Daisuke Chikuie, Minoru Takeuchi, Masuhiro ...

1983 Volume 76 Issue 5 Pages 1505-1515
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1505

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In order to evaluate the efficacy of AZ-S tablets (GASN 5mg) on pharyngitis, a double blind test was performed with AZ-U gargle tablets (GASN 2mg) as a control. The subjects were 45 patients with pharyngitis for AZ-S and 48 for AZ-U. All the AZ-S tablets were administered into the labiogingival region of the upper jaw.
1. AZ-S tended to be more effective for spontaneous pain and reddness of the pharyngeal mucous membrane than AZ-U (p<0.10). AZ-S was significantly more effective for swelling and discomfort in the pharynx (p<0.05).
2. Pharyngitis was cured in significantly shorter periods with AZ-S than with AZ-U (p<0.05).
3. Overall efficacy tended to be superior with AZ-S tablet (p<0.10).
4. No obvious side effect attributable to AZ-S or AZ-U was observed.
5. From the above results, AZ-S tablets administered into the labiogingival region of the upper jaw was considered to be more effective for pharyngitis than AZ-U gargle tablets.

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Effect of Saikokaryukotsuboreito on Men with Abnormal Sensation in the Throat

Mikikazu Yamagiwa, Haruki Fukuo, Yasuo Sakakura, Yasuro Miyoshi

1983 Volume 76 Issue 5 Pages 1517-1529
Published: May 01, 1983
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.76.1517

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Saikokaryukotsuboreito is a prescription of crude drugs and mainly contains pinelliae and magnolia. It has been used for the therapy of men with abnormal sensation in the throat in Kanpo medicine (Chinese traditional medicine inherited and developed in Japan).
The authors administered Tsumura-Saikokaryukotsuboreito (7.5g daily for two weeks) to a consecutive series of 50 male patients and evaluated the efficacy of the drug by analysing the patients' subjective signs and symptoms.
The drug was effective in 56% of the patients in a week, for 64% in 2 weeks and for 72% in 3 weeks (one week after the cessation of the drug). Side effects were minimal, and only one patient reported anorexia.
It was indicative that modern and traditional medicine combined might produce a higher rate of efficacy and usefulness in the therapy of abnormal sensation in the throat.

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