Practica Oto-Rhino-Laryngologica

Tinnitus in Patients Visiting Departments Other than Ear Nose and Throat

Hiroshi Hattori

1984 Volume 77 Issue 10 Pages 1879-1884
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1879

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The origins of tinnitus are not confined to diseases of the auditory system, but this symptom is also seen in patients with other somatic and/or psychological disturbances. It is sometimes a danger signal of hidden serious diseases.
It is, therefore, important to know how often and in what disease this symptom is found. Questionnaires were filled by doctors during history taking in the outpatient clinic. The number of patients with tinnitus were;
1. Orthopedic clinic
diseases of cervical vertebrae 11.3% (18/160)
thoracic and lumbar vertebrae 0.6% (2/340)
2. Neurosurgery clinic
infratentorial tumors 44.4% (16/36)
supratentorial tumors 3.3% (2/61)
3. Gynecology clinic
climacteric 37.5% (30/80)
4. Internal medicine clinic
i) diabetes mellitus 16.0% (23/144)
ii) chronic nephritis (under dialysis) 40.5% (47/116)
5. Ophthalmology clinic
hypertensive and diabetic retinopathy 38.5% (37/96)

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Functional Deafness in Children

Hiroko Ono, Shinro Ito, Mutsumi Hosoya

1984 Volume 77 Issue 10 Pages 1885-1891
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1885

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The popularized use of audiometric examinations in schools has recently led to an increased number of functional deafness.
The authors classified juvenile functional deafness as psychogenic deafness (chief complaint is deafness) and examination deafness (no complaint of deafness).
Both of them have specific audiometric and psychogenic findings, then it can basically be called “psychogenic deafness in the broad sense”.
The familiar and social environment have become complicated in an industrial country, and the difficulty of adapting to these situations may be one of the reasons for the increased incidence of functional deafness.
The treatment of this disorder requires a psychosomatic approach and for an earlier diagnosis of functional deafness, special examinations, such as CNV and LPC, provide valuable information.

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Somatosensory Nystagmus in Normal Subjects and Labyrinthine Loss Cases

Shuji Kotaka, Willum Bles

1984 Volume 77 Issue 10 Pages 1893-1898
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1893

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It is well known that somatosensory information is important in maintaining balance, as well as the visual and the vestibular inputs. However, it is difficult to analyse somatosensory input. Generally the analysis is done by the output of body sway and/or head movement, etc., but these outputs which consist of many components are difficult to analyse and to realize.
The simplest combination of muscles is the eye muscles group, so we used eye movement to analyse somatosensory information; i. e. somatosensory nystagmus (Bles, 1983).
The somatosensory contribution to nystagmus was demonstrated in stationary subjects stepping on a small circular treadmill (Rotary Drum System; Tönnies Co.) in darkness: the apparent stepping around test (Bles, 1981).
Sixteen normal subjects and 20 with labyrinthine loss were tested clockwise and counterclockwise by this method.
The slow build up of slow phase velocity (SPV) of somatosensory nystagmus and positive somatosensory after-nystagmus was found in normal subjects. On the other hand, there was a rapid increase of SPV of the somatosensory nystagmus and a lack of somatosensory after-nystagmus in patients with a bilateral loss of vestibular function.
These results suggest that there is a direct and an indirect pathway for somatosensory nystagmus in the mathematical model of the somatosensory-visual-vestibular interaction, which will be dealt with in a separate study.
The SPV of somatosensory nystagmus which receives information from all extremities is greater than the SPV of arthrokinetic nystagmus (Brandt, 1977) which receives input from the hands only.

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A Case of Spontaneous Perilymph Fistula

Yuichi Kurono, Shoichi Maeda, Goro Mogi

1984 Volume 77 Issue 10 Pages 1899-1905
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1899

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Spontaneous perilymph fistula was diagnosed in a 54-year-old man. The patient, who denied any episode of head trauma or ear disease, had a sudden sensation of plugging of the right ear without any hearing impairment or vertigo. A fluid-air line and a bubble were seen through the right tympanic membrane. Audiograms showed slight conductive hearing impairment. A tympanogram revealed type C findings. Vertical and horizontal nystagmus were detected in the head hanging position. The caloric test showed mild hypofunction of the right vestibule. Surgical exploration revealed slight dislocation of the stapes and a perilymphatic leak from the oval window. The fistula was closed with Gelform and fascia.
The clinical entity of perilymph fistula is characterized by episodic vertigo and sensorineural hearing impairment, and a case such as this one without these symptomes is very rare.

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CT Scan of Middle Ear Ossicles by Instillation of Liquid in the Tympanic Cavity

Kazuyuki Tashima, Iwao Honjo, Koichi Ushiro, Nobuya Yagi, Ryoichi Odan ...

1984 Volume 77 Issue 10 Pages 1907-1911
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1907

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Recent advances in CT scanning have permitted us to visualize the fine components of the temporal bone, such as ear ossicles, cochlea or facial canal to some extent. However, even with the latest CT scanner with high resolution, each ossicle cannot be fully depicted, because the partial volume effect obscures the fine structure of the ossicles. In order to minimize this effect, saline solution was instilled into the middle ear cavity through the ear drum. This procedure resulted in clear visualization of important parts of the ossicles, such as long process of the incus or incudostapedial joint. It appears feasible to use this method in the diagnosis of congenital ossicular malformations or acquired ossicular interruption.

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Prognosis and Submandibular Gland Function Bell's Palsy Evaluated by Submandibular Scan with ^99mTc

IInd Report

Chiyonori Ino, Toshio Yamashita, Mako Hanaoka, Tadami Kumazawa

1984 Volume 77 Issue 10 Pages 1913-1920
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1913

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Submandibular gland function was tested with ^99mTc-pertechnetate scan 10 days and 3-4 weeks after the onset Bell's palsy, and the results and prognoses were correlated.
In the first report we divided the cases into groups A, B and C, and this time group D classified in S. S. R. was poor.
Groups A and D can be differentiated by submandibular gland scan within 10 days after the onset; that is to say, the prognosis of more than half the cases can be determined in this early phase.
Especially, it is noticeable that group D showing the poor prognosis is differentiated within 10 days after the onset.
This method was compared with other tests of facial palsy.
Four to five weeks after the onset all tests were of equal accuracy in predicting the prognosis of each group.
Within 10 days after the onset, however, submandibular gland scan seems to be more useful than the other tests.

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A Case of Periosteal Desmoid Tumor Originating in the Temporal Bone

Haruhiko Ishida, Satomi Taniguchi, Takashi Fukazawa, Fumihiko Matsuyam ...

1984 Volume 77 Issue 10 Pages 1921-1927
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1921

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A 48-year old woman had complained of swelling of the right mastoid since 1977 and noticed hearing loss on the right and stenosis of the right external auditory canal in 1981. Surgery was performed in the same year, and the pathological diagnosis was periosteal desmoid tumor.
Periosteal desmoid tumor is considered to be on the borderline between benign and malignant. Local recurrence is frequent, but so far, she has not had any local recurrence. In our review of the literature we found no reports of periosteal desmoid tumor originating from the periosteum of the temporal bone.

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Sleep Apnea in the Field of Otolaryngology

Tatsuya Ishida, Jiro Udaka

1984 Volume 77 Issue 10 Pages 1929-1940
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1929

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The literature related to sleep apnea was reviewed, and the definition, etiology, clinical features, means of examination and management procedures were discussed.
1) The definition suggested by Guilleminault seems to be most useful for otolaryngologists.
2) If unrecognized and untreated, obstructive sleep apnea may lead to serious complications, e. g. cor pulmonale or pectus excavatum.
3) The status of the upper airway tract should be investigated in detail, and the obstructions should be discovered and relieved at an early stage of development.
4) Adenotonsillectomy may improve upper airway obstruction, and is thought to be very effective treatment for some patients with sleep apnea.

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A Case of Osteoma of the Mandibular Coronoid Process

Yasuyuki Tarui, Takashi Maki, Tetsuka Kijima, Tetsuzo Fujitani

1984 Volume 77 Issue 10 Pages 1941-1945
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1941

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A 16-year-old female had had gradually increasing limitation of movement of the jaw for six years.
A diagnosis was made of osteoma of the mandibular coronoid process. This was removed via a transantral approach to the pterygopalatine fossa.

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A Case of Posttraumatic Cyst of the Face

Satoshi Koike, Takashi Kawakami, Teruhiro Ogawa

1984 Volume 77 Issue 10 Pages 1947-1950
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1947

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As epidermoid and dermoid cysts arise from the fusion line of ectodermal tissue during the period of embryogenic development, most of these cases are congenital.
On the other hand, rare cases of acquired epidermoid cysts are considered to develop at site of previous injury because of epidermoid tissue implantation.
A 55-year-old male with a history of bullet injury in the maxillary bone 38 years ago had sudden swelling of the left cheek.
In this case a posttraumatic dermoid cyst resembled a malignant maxillary tumor.

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Surgery in Elderly Patients with Head and Neck Cancer

Akio Yoshida, Ken Okamoto, Ryuji Nagano

1984 Volume 77 Issue 10 Pages 1951-1959
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1951

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Nineteen patients over 70 years of age (13 men, 6 women) with head and neck cancer treated at the University of Occupational and Environmental Health were analyzed retrospectively. The primary site was in the larynx in 9 patients, in the paranasal sinuses in 4 patients, in the hypopharynx in 2 patients, and in the epipharynx, tongue, mouth floor and thyroid in 1 patient each. Seven of these patients underwent surgical resection: 3 total laryngectomies, 1 total maxillectomy, 1 hemiglossectomy with neck dissection, 1 Denker's operation and 1 pharyngolaryngoesophagectomy with neck dissection and reconstruction of the carotid artery. Eleven patients had associated illnesses. Hypertension and cardiac disease were most frequent. Postoperatively 1 patient developed cardiac failure and wound slough; he was discharged without any complications. The other patient who underwent pharyngolaryngoesophagectomy with reconstruction of the carotid artery died of cerebral herniation on the day following the operation. Even elderly patients should receive surgery, if it is indicated, but careful pre-, intra-, and postoperative management is always mandatory.

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Imaging of Thyroid Cancer with ²⁰¹Tl Chloride

Kunio Yanohara, Takeshige Nishimura, Michi Hyuga, Shigeru Miyoshi, Nob ...

1984 Volume 77 Issue 10 Pages 1961-1964
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1961

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²⁰¹Tl was used as an imaging agent in 56 cases of thyroid tumor to determine whether or not ²⁰¹Tl-scintigrams can precisely distinguish thyroid cancer from benign lesions.
Early and delayed ²⁰¹Tl scannings were performed on patients with thyroid tumors. Such tumors were free from uptake of ¹²³I or ^99mTc. In early scanning 21 of 38 cases showing positive ²⁰¹Tl scannings were benign and even in delayed scanning 10 of 22 cases were benign. It is concluded that ²⁰¹Tl has no affinity for thyroid cancer.

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The Adrenergic Innervation of the Eustachian Tube

Hajime Amano

1984 Volume 77 Issue 10 Pages 1965-1979
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1965

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There is much clinical evidence of a close relationship between the eustachian tube and the autonomic nervous system, especially in otitis media with effusion. However, the anatomical distribution of the autonomic nerves is not known.
Superficial and topographical adrenergic innervation of the tube was demonstrated by the glyoxylic acid method. The nerve fibers were most abundant in the pharyngeal area, sparser in the middle, and even fewer in the tympanic part. The fibers were arranged in an essentially longitudinal manner in all specimens. In the pharyngeal area, the adrenergic plexus formed a loose network of varicose fibers.
The cellular location of adrenergic nerves in the tube was then observed in freeze-dried sections by the Falck-Hillarp fluorescence method. Abundant adrenergic nerve fibers forming a network were observed around blood vessels, especially arteries of all the tubal regions. In the lamina propria of the tube, some varicose adrenergic nerve fibers ran separate from blood vessels, and they were abundant in the pharyngeal area. Adrenergic fibers were also seen around the tubal glands.
The superior cervical ganglion was transsected to investigate the adrenergic nerve pathways and their origin.
No adrenergic nerve was seen in the perivascular region or around the glands after transsection of this ganglion.
These studies show that the adrenergic nerve arises from the superior cervical ganglion and reaches the eustachian tube through the tympanic plexus and along the vessels supplying the tube from the external carotid artery.
The adrenergic nerve seems to affect the patency of the eustachian tube by controlling vasoconstriction. It is also speculated that patency of the tube is controlled by the adrenergic nervous system through the mucociliary system and the glands in the pharyngeal area.

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Tinnitus Measurement and Treatment

Part 2. Treatment of tinnitus by tinnitus maskers

Hitoshi Machii

1984 Volume 77 Issue 10 Pages 1981-1992
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1981

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Band-noise masker treatment was used in 101 patients with tinnitus who visited the otolaryngologic clinic of Nippon Medical School Hospital, and the degree of tinnitus was compared before and after treatment.
The tinnitus masker was designed so that a band noise ranging from 250 to 5000Hz was divided into 54 sections. The band noise masker was fitted to the tinnitus frequency obtained by the pitch match method and tinnitus was measured before and after masker treatment.
1) All patients were relieved of tinnitus while wearing the tinnitus masker, and the tinnitus was completely supressed or diminished (after effect) in 71% for 30min. to several months. 2) The after effect of masking was better in patients whose tinnitus frequencies were within in the frequency range of the band noise masker. 3) There was no correlation between the loudness of tinnitus and the after effect of masking. Even in patients with severe tinnitus of more than 20dB, the after effect of the tinnitus masker was obtained. 4) Tinnitus frequency showed no change after 2hr of masking. 5) In patients whose tinnitus diminished after masker treatment, the loudness balance method with the contralateral ear indicated the change in tinnitus loudness better than that with the ipsilateral ear or with the masking method. 6) The after effect of the masker was more frequently seen in patients whose tinnitogram showed a convergence type or congruence type than in patients who showed other types of tinnitogram.

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Experimental Study on Isolated Frog Semicircular Canal

A Vestibular Function Model

Mamoru Suzuki, Yasuo Harada, Takeshi Ariki, Yoshinori Sugata

1984 Volume 77 Issue 10 Pages 1993-2001
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.1993

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A frog's posterior semicircular canal was isolated in Frog Ringer's solution and stimulated by mechanical endolymphatic flow through a microsyringe connected to a micromanipulator. The motion of the cupula was visualized by gently injecting India ink into the ampulla.
1. The motion of the cupula appeared to be that of a “swinging door”, with the base of the cupula hinged on the crista.
2. Ampullofugal stimulation induced an action potential from the posterior canal fiber. This potential adapted in 6-7 seconds.
3. During mechanical endolymphatic flow, the cupula maintained its shifted position without swinging back to the neutral point. This indicates that adaptation is strictly sensorineural in origin.
4. An increase in spike discharge was observed when the canal was stimulated by a piece of frozen Ringer's solution. This indicates that counter flow in the Ringer's solution activated the ampullary sensory cells.
5. Responses from the vestibular nerve trunk were compared with those from the posterior canal fiber. The time course of the response was shorter and the maximum spike count was lower in recordings from the vestibular nerve trunk.

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Clinical Studies of Cefmenoxime Otic Solution

Toko Tatehara, Yutaka Sakamoto, Yoshihisa Kawasaki, Yasuko Urao

1984 Volume 77 Issue 10 Pages 2003-2011
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.2003

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A clinical evaluation was made of the efficacy of a new cephalosporin antibiotic, Cefmenoxime (CMX) Otic Solution for acute purulent otitis media, chronic purulent otitis media, chronic purulent otitis media with sudden exacerbation and acute diffuse otitis externa. Of the 31 patients treated, 24 showed definite improvement.
The main microorganisms detected were Staphylococcus aureus, Pseudomonas aeruginosa and Pseudomonas cepacia, against all of which CMX was effective in terms of MIC tests. It was further observed that CMX has gained better MIC figures and had a broader spectrum than other antibiotic agents such as CP, CEZ, or FRM.
No side effects were observed, and it may be concluded that CMX Otic Solution is clinically useful.

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Clinical Effect of N-5′ Tablets on Nasal Allergy

Yoshinori Kikuya, Yuko Ninomiya, Yasuo Harada, Shunbun Takebayashi, Ko ...

1984 Volume 77 Issue 10 Pages 2013-2021
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.2013

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N-5′ tablets were given to 36 patients with nasal allergy for 4 consecutive weeks.
Subjective improvement was noted in 77.7% and over-all improvement in 80.6%. The effects of this drug appeared within 1 week in 46.4%, within 2 weeks in 71.4% and within 3 weeks in all patients.
In 81.3% of the patients sneezing attacks were reduced, in 76.5% nasal discharge and in 72.2% nasal obstruction. Patients with sneezing and nasal discharge had better relief of symptoms than did those with nasal obstruction.
Abdominal pain and nausea were noted in one case, but these were not severe and disappeared after medication was stopped.
Synthetic evaluation showed moderate improvement in 77.8% and great improvement in 27.8%. Therefore, the authors consider that N-5′ tablets can be recommended for the treatment of nasal allergy.

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Clinical Use of Niflan^® (Pranoprofen) for Postoperative Pain

Koshiro Nakamura, Tetsuo Kozawa, Izuo Nishioka

1984 Volume 77 Issue 10 Pages 2023-2027
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.2023

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Niflan^® (Pranoprofen) was administered in a dose of 75mg (one capsule) to 20 patients with pain after otolaryngological surgery. The analgesic effect was determined by a pain analogue scale.
Niflan^® was effective in 85% of the patients within one hour after administraiton, and analgesia persisted for 6 hours or more in those with moderate pain.
Side effects were observed in 2 cases (abdominal pain and vomiting), but these symptoms may not have been directly due to the drug. It is concluded that Niflan^® is effective and safe in the relief of pain after otolaryngological surgery.

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[title in Japanese]

1984 Volume 77 Issue 10 Pages 2029-2076
Published: October 01, 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.2029

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Erratum to : Specific IgG Antibody to the Mite Dermatophagoides Farinae

1984 Volume 77 Issue 10 Pages e1
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10_e1

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