Three patients with brainstem neoplasms had cerebellopontine angle symptoms and unilateral cerebellopontine angle shadows on conventional CT scans. As there were involved facial, acoustic and trigeminal nerves in clinical symptoms, cerebellopontine angle syndrome was diagnosed and acoustic tumor was suspected. Otoneurological tests showed unilateral perceptive deafness with retrocochlear lesions, and the gaze test showed Bruns-Cushing type nystagmus.
In 19 patients with brainstem lesions, the ABR test results were all abnormal: loss of each component in 74% and prolonged latency of wave V in 24%. Most of the ABR test results in cases of intramedullary lesions with space-occupying effects in the brainstem were abnormalities in the presence and latency of wave V. It is concluded that the ABR test is helpful in determining the sites of intrinsic brainstem lesions.

View full abstract

Aural fistula is a congenital deformity of the external ear and is more common in Orientals than in Caucasians. Infection tends to occur, and conservative treatment with antibiotics is preferable to surgical drainage. Twenty-eight cases of infected aural fistula were studied from 1981 to 1983; 15 species and 51 strains of bacteria were isolated. Nonspore forming facultative anaerobes were detected in 20 cases. The chief pathogens were Peptococcus 33.3%, Staphyloccus aureus 9.8%, and Bacteroides 7.8%.
The Intial antibiotics selected statistically (by the theory of Expected Efficacy Index, EEI) were cefmetazole and lincomycin (injection) or clindamycin (oral).

View full abstract

Lidocaine (60mg for males, 40mg for females) injected intravenously in sixty-eight patients who complained of tinnitus.
The patients were divided into four groups according to their responses.
In twenty-four cases (35.3%), the tinnitus was abolished entirely. In twenty-nine cases (42.6%), the tinnitus was reduced partially. In eight cases (11.8%), the tinnitus was stationary. In seven cases (10.3%), the tinnitus increased. In the “Old Age” group and the “Low pitch tinnitus” group, intravenous lidocaine was more effective.
Of forty-nine patients who were given intravenous lidocaine at least four times, twenty-eight (57.1%) received partial relief for a long time.
The ABR findings suggested that intravenous lidocaine suppressed tinnitus by anesthesia of the brainstem.

View full abstract

Ten cases of so-called psychogenic vertigo are described.
These cases were classified into three groups according to the neurotological findings and organic disorders.
Group A showed no abnormal neurotological findings or any organic disorders.
Group B showed abnormal neurotological findings without any organic disorders.
Group C showed abnormal neurotological findings and organic disorders, but these organic disorders were not the cause of the vertigo.
Dysequilibrium and hearing impairment were common but nystagmus, canal paresis and abnormal OKN or ETT were not observed.
Diagnosis was not easy in some cases, so several diagnostic problems are discussed.

View full abstract

Rhinoscleroma is endemic in eastern Europe, North and Central Africa, and South and Central America. It is a rare disease in Japan. In 1917, Kuzume first reported a Japanese case of scleroma of the pharynx. Until 1982, only 3 Japanese cases had been reported. Rhinoscleroma is a chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here is a 41-year-old Japanese female. Her chief complaint is nasal deformity and nodular swelling of the nasal vestibule. Physical examination revealed: narrow nostrils, hard nasal wings, tumefaction of the left nostril, crusting of the nasal cavity, nodular swelling of the posterior wall of the naso- and mesopharynx, and scarring of the lateral wall of the pharynx. Laboratory findings were normal. The TB skin test was negative. A biopsy of the inferior turbinate showed a marked subepithelial infiltration with lymphocytes, plasma cells and macrophages. A PAS stain of the specimen showed large vacuolated histiocytes containing Klebsiella organisms (so-called Mikulicz cells). Klebsiella, Streptococcus agalactiae and Escherichia coli were recovered from the nasal secretion, and Klebsiella rhinoscleromatis was identified biochemically. The patient was treated with total doses of 20g of streptomycin and 8.4g of minocyclin and at the time of this writing is clinically free of disease.

View full abstract

We examined 21 patients with optic neuropathy caused by paranasal sinus cysts. Their findings on rhinoscopy were classified as follows; 1) normal (2 cases), 2) inflammatory changes of the middle meatus (2 cases), 3) postoperative scar formation of the middle meatus (7 cases), 4) presence of a cyst wall (10 cases).
Radiographic examination with Rhese's view showed destruction of the optic canal and/or an abnormal shadow in the paranasal sinus surrounding the optic canal in most cases.
For diagnosis, careful observation of the physical findings and radiographic findings by Rhese's view are important. CT scan is also useful.
In cases in which the visual disturbance progresses rapidly, probe puncture and/or probe operation is required if the clinical diagnosis has not yet been determined.

View full abstract

Distant metastases were observed in 28 cases (6.7%) in a series of 420 patients with laryngeal cancer treated from 1965 to 1980 in the Aichi Cancer Center.
The probability of distant matastases is higher in patients with advanced primary tumors, i. e. T₃ and T₄ lesions.
The most common first sites of distant metastases were the lungs (26 cases), skin, (8 cases), and bone (6 cases).
Forty-six percent of the metastases were detected by one year and over 90% by four years after surgery.
Until recently, distant metastases of laryngeal cancer were considered to be rare, but in over 90% of patients with distant metastases, the cause of death was distant metastasis, so early diagnosis and early treatment are necessary.
We recommend full metastatic screenicg (i. e. chest X-ray, liver scan, bone scan and radiographs) for these patients.

View full abstract

Vocal cord paralysis (VCP) was seen in 356 patients during a 7-year period in our clinic. Sixty percent of the patients were male. The left vocal cord was affected in 241 cases (68%), the right in 89 cases (25%) and both in 23 cases (6%). In one fourth the cause was thyroid cancer or thyroid surgery. Lung cancer was present in 8% and esophageal surgery in 7%. The cause was unknown in 27%.
In VCP due to thyroid cancer or thyroid surgery, there was a female preponderance and no difference in incidence between the left and the right vocal cords. The recovery rate was very low. VCP following endotracheal intubation had a very high rate of recovery.

View full abstract

A 74-year-old woman developed hoarseness in August, 1982, and then coughing, stridor and dyspnea. She visited our department on February 18, 1983. Total laryngectomy was performed, the histopathological diagnosis was chondroma presumably of the cricoid cartilage.

View full abstract

The value of serum immunosuppressive acidic protein (IAP) measured by the single radial immunodiffusion method was evaluated in 180 patients with head and neck cancer. A rise of IAP in untreated patients was noted in 92% of 12 patients with maxillary cancer, in 50% of 14 patients with oral cancer, in 65% of 23 patients with laryngeal cancer, in 71% of 7 patients with hypopharyngeal cancer, and 50% of 8 patients with other head and neck cancers. The serum IAP value rose with the progress of cancer, except in patients with liver cirrhosis. The serum IAP value, which rose temporarily after operation or irradiation therapy, decreased gradually with treatment.

View full abstract

Careful and complete removal of vascular tumors is challenging because of the brisk bleeding during operation. Preoperatively we used Gelfoam embolization of the feeding artery in juvenile angiofibroma and in paranasal capillary hemangioma. The intraoperative blood loss averaged 1045ml.
Angiography is of value to confirm the diagnosis prior to excision and to delineate the extent of the tumor. Embolization may be performed at the same sitting as preoperative treatment. Artificial embolization is described in detail, and preoperative embolization is recommended to make the surgical procedure easier in cases of vascular tumor.

View full abstract

The polarographic technique was used to examine the oxygen permeability of the round window membrane in 14 cats.
Under general anesthesia, a small hole was drilled in the first turn of the bony wall of the cochlea. An oxygen sensing microelectrode with a tip diameter less than 1μm was inserted through the hole into the scala tympani. Dynamic changes in perilymphatic oxygen tension were measured by applying compressed air, pure oxygen, carbogen (95% O₂+5% CO₂), and nitrogen gas to the round window membrane via the middle ear cavity.
1) The gasses easily pass through the round window membrane into the perilymphatic space.
2) The level of the perilymphatic oxygen tension is in part under the control of the oxygen concentration in the middle ear cavity.
3) A gradient in the perilymphatic oxygen tension is present, increasing with the distance from the round window membrane.

View full abstract

The middle ear mucosal epithelium in normal and pathological conditions was investigated by scanning electron microscope. In the normal middle ear cilia-bearing cells were frequently found in the floor and lower parts of the tympanic cavity. Most ciliated cells possessed about 80-200 cilia with an average length of approximately 7μ. Ciliated cells in the floor and lower parts of the tympanic cavity undoubtedly play an important role in the active mucociliary mechanism as they do in other parts of the respiratory system. Most of epithelial cells in the middle ear cavity were non-ciliated. Over 95% of epithelial cells were non-ciliated cells in the antrum and mastoid air cells. In pathological conditions, such as serous middle ear effusions, the density and the secretory activity of goblet cells were increased. There were a considerable number of small pores among the epithelial cells, through which inflammatory cells and mucous fluid-like substances came out. Ciliated cells showed sometimes abnormal figures such as short cilia, decreased number of cilia, knob formation, compound cilia and elongated cilia. These abnormal cilia may impede the mucociliary function of ciliated cells.
Thus, the accumulation of fluid readily occurs in the middle ear cavity under such circumstances.

View full abstract

The mutual interrelationships between the visual-ocular reflex (ViOR) and the vestibulo-ocular reflex (VeOR) are not completely understood yet. Optokinetic nystagmus (OKN) during ViOR was produced by rotating light stripes (Jung type). The whole visual field OKN, peripheral OKN, foveal OKN and hemianopsic OKN were produced with a Miyoshi-Shirato device.
Rotating nystagmus (RN) during VeOR was induced by a rotating chair.
OKN and RN were applied simultaneously to the same subject in the same direction and then in the opposite direction and vise versa.
1) The combined velocity of OKN and RN in the whole visual field was always constant, regardless of the phase of rotation.
2) When the peripheral OKN and RN were combined in the same direction, the velocity of the peripheral OKN was increased about 10-20%, compared to that in peripheral OKN only.
In contrast, when the peripheral OKN and RN were combined in the opposite direction, the velocity of the peripheral OKN was decreased about 10-20%.
3) In most of the subjects it was difficult to produce foveal OKN, and when RN was added to this OKN, the foveal OKN was not changed at all or suppressed in all four phases of rotation.
4) When the hemianopsic OKN and RN were combined in the same direction, the velocity of the former was increased and when they were in the opposite direction, the velocity of the former was decreased, regardless of whether hemianopsic OKN was temporal or nasal, foveopetal or foveofugal.

View full abstract

Fibrin sealant (Tisseel^®) is a newly developed tissue adhesive, a mixture of condensed fibrinogen including factor XIII, thrombin, aprotinin solution and calcium chloride solution. The adhesive process resembles that of coagulation of blood, and the material is finally absorbed while the tissue is being biologically connected. We used this sealer in 23 cases: 13 of middle ear surgery, 1 of closure of the internal auditory canal, 7 of facial nerve surgery, and 2 of closure of CSF fistulae. The results were excellent except in one case in which we attempted to close a dural defect of the internal auditory canal. Handling of the material is complicated, and condensation takes relatively long. But the high reliability of this material and its lack of tissue reaction more than balance these disadvantages. We conclude that the material is useful in many areas of ear and nose surgery.

View full abstract

The clinical effect of dihydroergotamine (DHE) was studied in 35 patients with orthostatic circulatory disorders and/or peripheral vertigo, principally Meniere's disease. These effects were assessed by subjective and objective parameters. Equilibrium and auditory functions were evaluated before and after medication by the same doctors. The drug dosage was 3-6mg of DHE daily for four weeks.
1) DHE was effective in 29 of 35 patients (82.8%) as judged by both subjective and objective parameters.
2) Subjective symptoms improved in 88.5% cases and objective symptoms in 82.8%.
3) No side-effects were observed during treatment.
Thus, DHE seemed to be effective and safe in the treatment of orthostatic circulatory disorders with or without peripheral vertigo.

View full abstract